Medicare Definition of Clean Claim
A “clean” claim is one that does not require the carrier or FI to investigate or develop external to their Medicare operation on a prepayment basis. Clean claims must be filed in the timely filing...
View ArticleWhy Medicare split the claim for process and when?
Splitting Claims for ProcessingThere are a number of prescribed situations where a claim is received for certain services that require the splitting of the single claim into one or more additional...
View ArticleRetroactive Medicare Entitlement - Medicare timely filing denial
The time for filing a claim will be extended if CMS or one of its contractors determines that a failure to meet the filing deadline is caused by all of the following conditions:(a) At the time the...
View ArticleQ: When is it acceptable to collect the deductible from the beneficiary?
This is the most sighted question from provider.A: When assignment is accepted, Medicare Part B recommends:• Since it is difficult to predict when deductible/coinsurance amounts will be applicable -...
View ArticleCMS - 1500 Claim Form Instructions: Revised for Form Version 02/12
Form Version 02/12 will replace the current CMS 1500 claim form, 08/05, effective with claims received on and after April 1, 2014:· Medicare will being accepting claims on the revised form,...
View Article2015 Annual Update for the Health Professional Shortage Area (HPSA) Bonus -...
Provider Action Needed:Change Request (CR) 8942 alerts you that the annual HPSA bonus payment file for 2015 will be made available by the Centers for Medicare & Medicaid Services (CMS) to your MAC...
View ArticleMEDICARE SPOT - Faxed reopening requests will not be accepted after November 30
Expedite your Part B clerical reopening requests with the ‘SPOT’ or IVRIn the past, providers had only two available methods to submit clerical reopening requests to First Coast Service Options Inc.:...
View ArticleWill Medicare pay G0101 AND Q0091
Payment for G0101 and Q0091 in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) that Bill Under the All-Inclusive Rate (AIR) System. Provider Types AffectedThis MLN Matters...
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How to submit document during first claim submission - detailed review - PWK...
PWK allows documentation to be submitted with an initial claimEffective October 1, 2012, First Coast Service Options Inc. (First Coast) implemented the PWK (paperwork) segment of the X12N version 5010....
View ArticleHow to fill/completing the PWK fax/mail coversheet
First Coast Service Options' (First Coast's) claims department is receiving a high volume of invalid or unnecessary PWK (5010 paperwork segment) fax/mail coversheets. If a coversheet is received...
View ArticleWhen to file an appeal - Big question in Medical billing
Once an initial claim determination is made, providers, participating physicians, and other suppliers have the right to appeal. Physicians and other suppliers who do not take assignment on claims have...
View ArticleMedicaid increases the payment of Pediatric
Pediatric Physician Rate IncreaseEffective January 1, 2015, Current Procedural Terminology (CPT®) codes 99201 through 99496 will be reimbursed with an enhanced rate to pediatric physicians billing...
View ArticlePreventive Services and Screenings Covered by Medicare and Waiver of...
• Abdominal Aortic Aneurysm Screening• Alcohol Misuse Screening and Behavioral counseling Intervention in Primary Care• Annual Wellness Visit (Including Personalized Prevention Plan Services)•...
View ArticleAdditional Services covered during wellness visit
Medicare covers a one-time only Abdominal Aortic Aneurysm (AAA) Screening for at-risk members when a referral for the screening is received as a result of the wellness exam. In 2014, this service is...
View ArticleNon practitioners billing - Incident service - Medicare guidelines
"Incident to" and the Initial Visit - Evaluation & Management (E/M) Service GuidelinesNovitas Solutions Medical Review (MR) Department has observed a continued trend of the utilization of...
View ArticleNursing Home Five-Star Rating System review
CMS Announces Two Medicare Quality Improvement InitiativesAdministration redoubles its efforts to improve quality of post-acute care for Medicare beneficiariesToday, the Centers for Medicare &...
View ArticleAssistant surgery modifiers
Appropriate use of assistant at surgery modifiers and payment indicatorsFirst Coast Service Options Inc. (First Coast) would like to remind providers within jurisdiction N (JN) of the appropriate use...
View Articlewhat are cases Medicare would be secondary
Medicare As Secondary PayerUntil 1980, Medicare was the primary payer for all Medicare covered services except for services covered by workers' compensation or black lung benefits or paid for by the...
View ArticleMedicare benefit when patient has worker compensation , veterans...
d. Worker's CompensationMedicare is secondary to Worker's Compensation benefits if the patient is being treated for a work related illness or injury. If the claim is contested, pending the Worker's...
View ArticleMSP Billing Procedures - Detailed reveiw
a. General RequirementsWhen Medicare is the secondary payer, the claim must first be submitted to the primary insurer. The primary insurer must process the claim in accordance with the coverage...
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