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…

CMS Finalizes Definition of “Reasonable and Necessary”

A definition of “reasonable and necessary” is part of the recently finalized rule,  Medicare Program; Medicare Coverage of Innovative Technology (MCIT) and Definition of ‘‘Reasonable and Necessary’’.   As previously reported this rule also establishes a Medicare coverage pathway to provide Medicare beneficiaries nationwide with faster access to new, innovative medical devices designated as breakthrough by…

CMS Proposes Definition of Reasonable and Necessary

A definition of “reasonable and necessary” was part of the recently proposed rule, Medicare Program; Medicare Coverage of Innovative Technology (MCIT) and Definition of ‘‘Reasonable and Necessary’’.  This proposed rule would also establish a Medicare coverage pathway to provide Medicare beneficiaries nationwide with faster access to new, innovative medical devices designated as breakthrough by the Food…

CMS Issues Provider Enrollment Updates and Rural Add-on Tables

Deactivations The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 10443 that updates Medicare Program Integrity Manual related to policies for Medicare provider deactivations. The changes align the reasons for deactivation more accurately with the regulations at §242.540 and include several small changes in chapter 15 of the manual under sections 15.27and15.29.…