CMS Updates Enrollment Decision Appeals Procedure

The Centers for Medicare & Medicaid Services (CMS) updated Chapter 15 – Medicare Enrollment –  of the Medicare Program Integrity Manual via Change Request (CR) 11210/Transmittal 936 Provider Enrollment Appeals Procedure. This CR deals with provider enrollment appeals and  provides instructions to the Medicare Administrative Contractor (MAC) on handling  reconsideration requests and Corrective Action Plans…

CMS Updates Medicare Benefit Policy Manual for Home Health Agencies

The Centers for Medicare & Medicaid (CMS) recently released Transmittal 265/Change Request (CR) 11577 Manual Updates Related to Calendar Year (CY) 2020 Home Health Payment Policy Changes, Maintenance Therapy, and Remote Patient Monitoring This CR updates the Medicare Benefit Policy Manual, (Publication 100-02), Chapter 7, to reflect policy changes finalized in the CY 2019 and…

CMS Updates Claims Processing Manual

The Centers for Medicare & Medicaid Services (CMS) has again updated Change Request (CR) 11081 – Home Health (HH) Patient-Driven Groupings Model (PDGM) – Split Implementation through Transmittal 4489. As previously reported, this CR has been updated more than once since its original publication in early 2019 (see previous NAHC Report coverage here and here).…

CMS Releases Revised and Additional Instructions for Billing Under PDGM

The Centers for Medicare & Medicaid Services (CMS) released Transmittal 4378/Change Request (CR) – Home Health (HH) Patient-Driven Groupings Model (PDGM) – Revised and Additional Manual Instructions. This transmittal  revises additional sections of the CMS Claims Processing Manual, Chapter 10, to support the implementation of the HH PDGM and creates new sections to describe the…

CMS Issues Two New Change Requests for Medical Review

The Centers for Medicare & Medicaid Services (CMS) recently issued two Change Requests (CR) related to medical review: Change Request 10930 – Templates in Medical Review and Change Request 10963 – One-on-One Education. CR 10930 updates the Medicare Program Integrity Manual to clarify that CMS does not prohibit the use of templates to facilitate record-keeping.…