The Centers for Medicare and Medicaid Services has issued a booklet explaining the Medicare enrollment process and claim submission guidelines. The information in this publication applies only to the Medicare Fee-For-Service Program. Information discussed in the booklet includes: enrolling in the Medicare program, submission of Medicare claims including timely filing requirements, deductibles, coinsurance and deductibles, beneficiary notices of noncoverage, billing requirements, and claim processing. To access the booklet, click

UnitedHealthcare Medicare Solutions has announced they have

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.

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.

Wisconsin Physician Services (WPS) will be hosting an outpatient therapy seminar on September 25, 2014 in Merrillville, IN. Topics covered in the program include the following: Requirements for a Plan of Care Certifications and Recertifications Evaluations and Reevaluations  Therapy Caps Advanced Beneficary Notice of Noncoverage Documentation Requirements  Functional Reporting Requirements For additional information and to register, click HERE.

Noridian Healthcare Solutions will provide a teleconference on August 28, 2014 to discuss the Medicare outpatient Functional Limitation Reporting program (i.e. G-codes). For additional information how to participate, click HERE.

Wisconsin Physician Services (WPS) will be providing a teleconference on October 1, 2014 on documenting medical necessity for major joint replacements (hips and knees). This educational event is intended to improve compliance with documentation requirements for major joint replacement surgery. For additional information and to register, click HERE.

The Centers for Medicare and Medicaid Services (CMS) is establishing four new Healthcare Common Procedure Coding System (HCPCS) modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.” Currently, providers can use the -59 modifier to indicate that a code represents a service that is separate and distinct from another service with which it would usually be considered to be bundled. Because it can be so broadly applied, some providers incorrectly consider it to be the “modifier to use to bypass National Correct Coding Initiative (NCCI)”, it is the most widely used modifier.