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09/02/14

UHC Delays FLR

UnitedHealthcare Medicare Solutions has announced they have

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09/02/14

Automation of the Request for Reopening Claims Process

The Centers for Medicare and Medicaid Services (CMS) have issued instructions in changes to the Reopening process for non-private practices (i.e. institutional settings). These changes were necessary due to a non-standard approach of requesting a Reopening from one Medicare Administrative Contractor (MAC) to another. In an effort to streamline and standardize the requesting process, CMS has petitioned the National Uniform Billing Committee (NUBC) for a “new” bill type frequency code that can be used by providers to indicate a Request for Reopening and a series of Condition Codes that can be utilized to identify the type of Reopening being requested.

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09/02/14

Skilled Nursing Facility Certifications & Recertifications

The Centers for Medicare and Medicaid Services (CMS) has issued a special publication that alerts providers that a major reason for claims being denied is failure to obtain certification and recertification statements from physicians or NPPs. The routine admission order established by a physician is not a certification of the necessity for post hospital extended care services for purposes of the program. Your therapy and billing staff needs to be aware of the requirements outlined below of what is an acceptable certification statement, what is an acceptable recertification statement, and how and when to document the certification and recertification statements.

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