The Centers for Medicare & Medicaid Services (CMS) is proposing to expand coverage in section 210.7 of the Medicare National Coverage Determinations (NCD) Manual. CMS proposes that the evidence is adequate to conclude that screening for HIV infection for all individuals between the ages of 15 and 65 years, as is recommended with a grade…
Starting January 5, 2015, the “Medicare Treatment Authorization” field must contain blanks or valid Medicare data in the first 14 bytes of the treatment authorization field for direct data entry (DDE) and hardcopy claims and at the loop 2300 REF02 (REF01=G1) segment for the ASC X12 837 claim. Institutional claims submitted without blanks or valid…
90791 Psych diagnostic evaluation90792 Psych diag eval w/med srvcs90832 Psytx pt&/family 30 minutes90833 Psytx pt&/fam w/e&m 30 min90834 Psytx pt&/family 45 minutes90836 Psytx pt&/fam w/e&m 45 min90837 Psytx pt&/family 60 minutes90838 Psytx pt&/fam w/e&m 60 min90951 Esrd serv 4 visits p mo <2yr90952 Esrd serv 2-3 vsts p mo <2yr90954 Esrd serv 4 vsts p…
Effective January 1, 2014 Medicare contractors are required to issue a notice of Medicare redetermination after an appeal is requested in accordance with 42 CFR Section 405.956. One of the elements in the MRN is the beneficiary’s HICN (Health Insurance Claim Numbers). To ensure that contractors protect personally identifiable information, the Centers for Medicare &…
Earlier the status of Medicare claims can be obtained only through automated phone system but now all Medicare contractors are working closely with CMS to integrate “Individuals Authorized Access to the CMS Computer Services (IACS)” to offer secure and fast access to beneficiary eligibility, claims status, online remittances, financial information, PQRS and eRx incentive details,…
The Centers for Medicare & Medicaid Services recently undertook a re-design of the Medicare Summary Notice (MSN) – see CR 7676. It was decided that this was an ideal opportunity to revise many of the outdated, complicated, and obsolete MSN messages currently in use. Complicated, difficult to understand MSN messages were revised to plain language…
Payment rates for an individual service are based on the following three components: 1) Relative Value Units (RVU); 2) Conversion Factor (CF); and 3) Geographic Practice Cost Indices (GPCI). Each component is discussed in more detail below. 1) Relative Value Units (RVU) Three separate RVUs are associated with the calculation of a payment under the…
The National Committee for Quality Assurance (NCQA) and the Centers for Medicare & Medicaid Services (CMS) require health plans to conduct a member satisfaction survey called the Consumer Assessment of Healthcare Providers and Systems (CAHPS). Results are produced annually and compared with national benchmarks. The surveys are administered in early spring by mail, with telephonic…
The CMS-HCC risk adjustment model is prospective—it uses demographic information (age, sex, Medicaid dual eligibility, disability status) and a profile of major medical conditions in the base year to predict Medicare expenditures in the next year. It is calibrated on the FFS population because this population, unlike the MA population, submits complete Medicare claims data,…
Abortions are not covered Medicare procedures except: If the pregnancy is the result of an act of rape or incest; or In the case where a woman suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by or arising from the pregnancy itself, that would, as certified by…