Tag: Program Integrity Manual

Transition of Enrollment and Certification Activities for Hospices

The Centers for Medicare & Medicaid Services (CMS) recently released Change Request (CR) 12868 which updates Chapter 10 of CMS Publication (Pub.) 100-08, Program Integrity Manual (PIM), with instructions regarding the processing of various certified provider and supplier enrollment transactions including hospices. The effective date of the updates has been moved from September 30 to…

Program Integrity Manual Updated for Identity Theft and Hospice Aggregate Cap Liability

The Centers for Medicare & Medicaid Services (CMS) recently released a new transmittal that updates the chapter of the Program Integrity Manual to address coordination between Medicare Administrative Contractors (MAC) and Unified Program Integrity Contractors (UPIC) in situations of hospice aggregate cap liabilities, as well as addressing Medicare liabilities in situations of provider identity theft.…

CMS Issues Rebuttal Process for Deactivations

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 10978, which provides instructions to the contractors and updates the Program Integrity Manual on provider’s/supplier’s right to a rebut a deactivation of their Medicare billing privileges. A provider/supplier whose Medicare billing privileges have been deactivated may file a rebuttal. A rebuttal provides…

CMS Releases Transmittals to Update Manuals to Reflect Home Health Final Rule 2019 Changes

The Centers for Medicare & Medicaid Services (CMS) released two transmittals on March 22, 2019 that update CMS manuals to reflect changes made by the CY2019 Home Health Final Rule to the updated plan of care requirements and the elimination of the requirement that the physician estimate the length of home health services at recertification.…

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.…

CMS Updates Program Integrity Manual to Clarify MAC Responsibilities Related to Provider/Supplier Revalidation

On December 29, 2017, the Centers for Medicare & Medicaid Services (CMS) issued Change Request 10386/Transmittal 762, which modifies chapter 8 of the Program Integrity Manual to clarify Medicare Administrative Contractor (MAC) requirements for issuing revalidation approval letters and for releasing revalidation status information to callers over the phone.  The changes reflected in the transmittal…