Tag: Medicare Administrative Contractors

Quarterly Credit Balance Reports Due Soon

As a reminder, the Medicare Credit Balance Report for the quarter ending September 30th is due by October 30, 2022. The Centers for Medicare & Medicaid Services (CMS) requires participating providers to furnish information about payments made to them and to refund any monies incorrectly paid in a timely manner. The form CMS-838 is used to…

CMS Transitions Administrative Functions for HHA Enrollments and CHOWs

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 12749 that describes the transitioning of certain certification enrollment functions performed by the CMS Survey and Operations Group (SOG) Locations (formerly CMS Regional Offices) to CMS’ Center for Program Integrity (CPI) Provider Enrollment Oversight Group (PEOG) and the Medicare Administrative Contractors (MACs). To…

CMS Revises Manual instruction Related to Misuse with the NOA

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12595 to update various sections within Chapter 4 of the Medicare Program Integrity Manual, including the removal of references to Request for Anticipated Payment (RAP) suppressions. The CR also adds program integrity policies around abuses with the Notice of Admission (NOA). CMS…

FY2022 Hospice Medicare and Medicaid Base Rates at a Glance

Hospice Medicare FY2022 Pricer Now Available Beginning October 1, 2021, hospice base payment rates will increase by two percent, as published in the final FY2022 Hospice Payment Rule. As is customary, the Medicaid program waits until Medicare rates are finalized to issue guidance on the applicable corresponding hospice payment rates. The Medicaid Financial Management Group…

Process Revisions for Changes of Information for Medicare Certified Providers

The Centers for Medicare & Medicaid Services (CMS) recently released revised instructions (Transmittal 10975/Change Request (CR) 12386) for processing of Medicare-certified provider information,  transitioning certain functions from the  Survey & Operations Group (SOG) Locations (formerly known as Regional Offices) to the Medicare Administrative Contractors (MACs) and the Provider Enrollment & Oversight Group (PEOG), which is part…

Billing for E&M Services: Cognitive Assessment and Care Planning

Transmittal 10718/Change Request (CR) 12247, released April 26, 2021 by the Centers for Medicare & Medicaid Services (CMS) provides instructions to Medicare Administrative Contractors (MACs) for outreach and education on cognitive assessment and care planning services provided by physicians, physician assistants, nurse practitioners and other clinicians able to bill for Evaluation and Management (E&M) services. CMS is…

CMS Releases Updated Manual Guidance for the Hospice Election Statement and Addendum

The Centers for Medicare & Medicaid Services (CMS) updated the Medicare Benefit Policy Manual, Chapter 9 to reflect changes to the hospice election statement and the new election statement addendum.  CMS Transmittal 10437/Change Request (CR) 12015 revises the Manual to include the following:  In the fiscal year (FY) 2020 Hospice final rule (84 FR 38484),…

CMS Updates Home Health Claim Processing Instructions for Unsolicited Responses

The Centers for Medicare & Medicaid Services (CMS) recently updated the claims processing instructions for Medicare Administrative Contractors (MACs), including instructions for processing multiple unsolicited responses on the same home health claim. Prior to the implementation of PDGM (Patient Driven Groupings Model), there was no need for multiple unsolicited responses to be processed during the…

CMS Releases Interim Final Rule for COVID-19 Vaccine & Treatment, and CARES Act Provisions

Late in the day on Wednesday, October 29, the Centers for Medicare & Medicaid Services (CMS) released an Interim Final Rule with Comment Period (IFC) primarily addressing COVID-19 vaccine coverage. The provisions of the IFC are effective immediately on the date of posting in the Federal Register or as otherwise specified in the rule. The…

Medicare Contractors Were Not Consistent In How They Reviewed Extrapolated Overpayments

The Office of Inspector General (OIG) of the Department of Health and Human Services conducted an audit to determine whether the Centers for Medicare & Medicaid Services (CMS) ensured that MACs and QICs reviewed appealed extrapolated overpayments consistently and in a manner that conforms with existing CMS requirements. The OIG concluded that the MACs and…