The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) review revisions for cost reporting periods ending on or after December31, 2016, according to the Medicare Provider Reimbursement Manual updates given. Full Transmittal: https:/​/​www.cms.gov/​Regulations-and-Guidance/​Guidance/​Transmittals/​2017Downloads/​R14P229.pdf Subject: NEW/​REVISED MATERIAL–EFFECTIVE: Cost reporting periods ending on or after December 31, 2016 Number: 14 Title: N/​A Release […]

The Centers for Medicare & Medicaid Services (CMS) requests that Medicare Administrative Contractors (MACs) review changes to the Medicare Physician Fee Schedule Database (MPFSDB) for April 2017. MACs are instructed to update their systems and send a receipt notification by email to price_file_receipt@cms.hhs.gov, stating the name of the file received and the entity for which […]

The Centers for Medicare & Medicaid Services (CMS) requests that a contractor for the CMS drug program, General Dynamics Information Technology, make changes to the VIPS Medicare System (VMS). Full Transmittal: https:/​/​www.cms.gov/​Regulations-and-Guidance/​Guidance/​Transmittals/​2017Downloads/​R1796OTN.pdf Subject: Processing Updates for VMS From Provider Enrollment, Chain and Ownership System (PECOS) Extract File Number: 1796 Title: 9962 Release Date: Feb. 10, […]

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) to make payment for Advance Care Planning according to system changes. CMS has made the CPT code 99497 for Advance Care Planning (ACP) separately payable for Medicare OPPS claims when the service meets the criteria for separate payment under OPPS. A Medicare […]

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) utilize an indicator of Qualified Medicare Beneficiary (QMB) status to the Medicare Fee-For-Service claims processing systems. The QMB program assists low-income Medicare beneficiaries, who, by federal law, pay no Medicare deductibles, copays, or coinsurance. CMS instructs MACs to create a new beneficiary […]

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) implement changes to the National Coordination of Benefits Agreement (COBA) crossover process according to a Social Security Number Removal Initiative (SSNRI) undertaken by CMS consistent with the Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA) of 2015. CMS provides […]

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) handle payments and make changes to the Common Working File (CWF) for the addition of influenza virus vaccine code 90682. Contractors must accept claims with dates of service on or after July 1, 2017. Contractors must make payments, adjust claims and otherwise […]

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) use a five digit county code for the purposes of implementing an out migration adjustment that used to be done manually. The county code will go on inpatient and outpatient Provider Specific Files (PSF). A Pricer will calculate appropriate wage index for […]

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) publish an update to IOM, Medicare Claims Processing Manual with a revision. Contractors shall delete the Type of Bill codes list, which is outdated. Contractors shall be aware of the IOM Chapter 25 changes. Full Transmittal: https:/​/​www.cms.gov/​Regulations-and-Guidance/​Guidance/​Transmittals/​2017Downloads/​R3709CP.pdf Subject: Internet Only Manual (IOM) […]

The Centers for Medicare & Medicaid Services (CMS) requests Medicare Administrative Contractors (MACs) utilize a new National Correct Coding Initiative (NCCI) set of procedure to procedure edits (PTP) known as Version 23.1, which will be effective April 1, 2017, available via the CMS Data Center (CDC), for correct payment of Medicare Part B claims. Contractors […]