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    • November 27, 2017

    Positron Emission Tomography (PET) is a nuclear medicine imaging study used to detect normal and abnormal tissues. All PET scan services are billed using PET or PET/ Computed Tomography (CT) CPT codes 78459, 78491, 78492, 78608, and 78811 through 78816. Each of these CPT codes always requires the use of a radiopharmaceutical code, also known as a... more

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    • November 27, 2017

    Each year the dollar amount in controversy required to sustain appeal rights may be adjusted. The Social Security Act (the Act), requires an annual reevaluation of the dollar amount in controversy required for an Administrative Law Judge (ALJ) hearing and for Federal District Court review.  The amount that must remain in controversy... more

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    • November 27, 2017

    As part of the broader HHS commitment to improving the Medicare appeals process, CMS will make available an additional settlement option for providers and suppliers (appellants) with appeals pending at the Office of Medicare Hearings and Appeals and the Medicare Appeals Council at the Departmental Appeals Board. See the Appeals Settlement... more

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    • November 27, 2017

    This article is based on information received from Medicare beneficiaries, their legal counsel, and other entities that assist these individuals, indicating that physicians, providers, and other suppliers are often reluctant to accept payment directly from Medicare beneficiaries who state they have a MSA and must pay for their services themselves... more

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    • November 27, 2017

    Change Request (CR) 10124 alerts providers that their MAC will provide revised fax/mail cover sheets via hardcopy and/or electronic download. These revised documents are attached to CR10124. There are three paperwork (PWK) attachments to CR10124: (1) Medicare Part A Fax/Mail Cover Sheet (2) Medicare Part B Fax/Mail Cover Sheet and (3) Medicare DME... more

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    • November 27, 2017

    CMS’s new leadership is re-examining existing corrective actions and exploring new and innovative approaches to reducing improper payments, while minimizing burden for its partners. Due to the successes of actions we put into place to reduce improper payments, the Medicare Fee-For-Service (FFS) improper payment rate decreased from 11.0 percent in... more

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    • November 27, 2017

    CMS has identified an issue with the implementation of Change Request (CR) 9911 which modified the Medicare Remittance Advice (RA) for Qualified Medicare Beneficiary (QMB) claims to indicate the QMB status of patients and reflect zero cost-sharing liability. These beneficiaries are covered by both Medicare and Medicaid. On October 2, 2017 Change... more

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    • November 27, 2017

    CMS notified supplemental insurers (e.g., Medigap plans, employer retiree plans, TRICARE for Life, FEHBP plans) and State Medicaid Agencies about the transition from Social Security Number based Health Insurance Claim Numbers (HICNs) to new numbers (known as Medicare Beneficiary Identifiers (MBIs)) on several occasions, including two calls on... more

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