News & Updates

The time limits for filing appeals vary according to the type of appeal: Redetermination – The time limit for filing a request for redetermination is 120… Read More »TFL for Each Level of Appeal

CMS is committed to implementing the Medicare program in accordance with all applicable laws and regulations, including timely claims processing.  Several Medicare legislative provisions affecting… Read More »Expired Medicare Legislative Provisions and Therapy Claims with the KX Modifier Rolling Hold

The time limit for filing a request for redetermination may be extended in certain situations. Generally, providers, physicians, or other suppliers are expected to file… Read More »Good cause for extension of the time limit for filing appeals

President Trump called on Democrats and Republicans to repeal and replace Obamacare with reforms that expand choice, increase access, lower costs, and provider better healthcare.… Read More »President Trump to replace Obamacare

CMS discovered systems errors affecting claims with new drug testing laboratory codes (HCPCS codes G0477 through G0483) with dates of service on or after January… Read More »Medicare will hold HCPCS codes G0477 through G0483 till April 04, 2016

CMS is currently revising the Inpatient Prospective Payment System (IPPS) FY 2016 Pricer to reflect the new payment calculation requirement.  The amount of the payment… Read More »Inpatient Hospital Payment Rate Impacted by the Consolidated Appropriations Act, 2016

On April 14 , 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015; the President is expected to sign it shortly.  This… Read More »Information Regarding the Medicare Access and CHIP Reauthorization Act of 2015

WEEKLY INFLUENZA SURVEILLANCE Flu activity is high across most of the country with flu illnesses, hospitalizations and deaths elevated. Flu season will probably continue for several… Read More »CDC Influenza News and Highlights

New Manual Helps Hospitals Improve Medication Reconciliation The AHRQ-funded Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) has produced an implementation manual to help hospitals improve… Read More »Agency for Healthcare Research and Quality (AHRQ)

CMS issued Change Request (CR) 8851 edit spreadsheet changes for Professional electronic claims. The Professional edit changes below will be implemented the morning of April 4,… Read More »Important edit changes for Professional claims effective April 4, 2015