Medicare News
Providers Enrolled as a ‘Sole Practitioner’, or ‘Private Practice’– Claim Submission Requirements for the Billing and Rendering Information
If you are enrolled as a ‘Sole Practitioner’, or ‘Private Practice’ Provider, only the Billing NPI assigned should be submitted on the claim. It is not required to also report an NPI as the Rendering Provider. Incorrectly reporting a Rendering Provider NPI that is not required, the system will automatically reject the claim based on the system editing for the Billing and Rendering information. To learn more, click here.
One to One Education for Providers With Zero Claims Reviewed During Two Midnight
Adjustment of Some Hospital Claims for Therapy Services
Certain hospital claims for therapy services processed between April 7 and July 28, 2014 may have been paid in error because Medicare claims processing systems did not apply the services to the therapy cap appropriately. The claims affected had one or more lines with revenue code 042x, 043x, or 044x with modifier GN, GO, or GP. The system problem was corrected on July 28 and the affected claims will be adjusted. No provider action is needed.
Providers Enrolled as a ‘Sole Practitioner’, or ‘Private Practice’– Claim Submission Requirements for the Billing and Rendering Information
If you are enrolled as a ‘Sole Practitioner’, or ‘Private Practice’ Provider, only the Billing NPI assigned should be submitted on the claim. It is not required to also report an NPI as the Rendering Provider. Incorrectly reporting a Rendering Provider NPI that is not required, the system will automatically reject the claim based on the system editing for the Billing and Rendering information. To learn more, click here.
One to One Education for Providers With Zero Claims Reviewed During Two Midnight
Due to a variety of circumstances, The Centers for Medicare and Medicaid Services (CMS) has limited Medicare Administrative Contractor claim review samples during the first Probe & Educate process. While we anticipate most facilities will be subject to medical review, if a provider has not submitted any claims for billing or has not been selected for medical review during the last several months, they may still receive generalized education on the final rule. Please contact your Medicare Administrative Contractor if you would like to receive educational information related to CMS Final Rule 1599, as it relates to the appropriateness of inpatient admissions.
Part A Top Inquiries
The Part A Top Inquiries Frequently Asked Questions (FAQs) have been updated. Please take time to review these FAQs for answers to your questions.
Part A Top Inquiries
The Part A Top Inquiries Frequently Asked Questions (FAQs) have been updated. Please take time to review these FAQs for answers to your questions.
Adjustment of Some Hospital Claims for Therapy Services
Certain hospital claims for therapy services processed between April 7 and July 28, 2014 may have been paid in error because Medicare claims processing systems did not apply the services to the therapy cap appropriately. The claims affected had one or more lines with revenue code 042x, 043x, or 044x with modifier GN, GO, or GP. The system problem was corrected on July 28 and the affected claims will be adjusted. No provider action is needed.
