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Medicare Billing

CMS Updates for Telehealth billing

GT Modifier limited to CAH billing Previous guidance instructed providers to submit claims for telehealth services using the appropriate procedure code along with the telehealth modifier GT (via interactive audio and video telecommunications systems). In the Calendar Year (CY) 2017 Physician Fee Schedule (PFS) final rule, payment policies regarding Medicare’s use of a new Place of Service...

CMS Renames Locum Tenens Arrangements

Changes to the Payment Policies for Reciprocal Billing Arrangements and Fee-For-Time Compensation Arrangements (formerly referred to as Locum Tenens Arrangements) The Centers for Medicare & Medicaid Services (CMS) is amending the terminology it uses to describe locum tenens arrangements. Moving forward, CMS will describe these agreements as “Fee-For-Time Compensation Arrangements”.  The reason for the...

QMB Indicator in the Medicare fee-for-service claims processing system

Under federal law, Medicare providers may not bill individuals enrolled in the QMB program for Medicare deductibles, coinsurance, or copayments, under any circumstances.  State Medicaid programs may pay providers for Medicare deductibles, coinsurance, and copayments. However, as permitted by Federal law, states can limit provider reimbursement for Medicare cost-sharing under certain circumstances. Nonetheless, Medicare...

Medicare DMEPOS Requiring Prior Authorization

Beginning January 2017, certain DMEPOS items will require prior authorization from the Medicare Administrative Contractor. Prior authorization is a process through which a request for provisional affirmation of coverage is submitted to a medical review contractor for review before the item or service is furnished to the beneficiary and before the claim is submitted...

Medicare Social Security Number Removal Initiative

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019.  A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number on new Medicare cards for transactions like billing, eligibility status, and claim status....