Medicare Claims Rejected
Special Edition of CMS MLN Connects November 12,2019
HICN Claims Reject
We are 50 days out from the end of the Medicare Beneficiary Identifier (MBI) transition period. Use the MBI on Medicare claims and other transactions now. Starting January 1, regardless of the date of service:
- We will reject claims submitted with Health Insurance Claim Numbers (HICNs) with a few exceptions
- We will reject all eligibility transactions submitted with HICNs
See the MLN Matters Article to learn how to get and use MBIs.
HealthSmart Update
Bentegrity/TACT termination from HealthSmart
POET has been informed as of October 31, 2019 Bentegrity/TACT has termed from their HealthSmart agreement.
If you have any questions, please call us..
New Medicare Card: HICN Claims Reject January 1, 2020
from CMS MLN Connects
Starting January 1, you must use Medicare Beneficiary Identifiers (MBIs) when billing Medicare regardless of the date of service:
- We will reject claims submitted with HICNs with a few exceptions
- We will reject all eligibility transactions submitted with Health Insurance Claim Numbers (HICNs)
See the MLN Matters Article to learn how to get and use MBIs.
CMS issues final rules for 2020
Physician Fee Schedule: Finalized Policy, Payment, and Quality Provisions for CY 2020
from CMS MLN Connects:
On November 1, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2020.
Payment Provisions:
- Ratesetting and conversion factor
- Medicare telehealth services
- Evaluation and management services
- Physician supervision requirements for physician assistants
- Review and verification of medical record documentation
- Care management services
- Medicare coverage for opioid use disorder treatment services furnished by opioid treatment programs
- Bundled payments under the PFS for opioid use disorders
- Therapy services
Other Provisions:
- Quality Payment Program
- Ambulance services
- Ground ambulance data collection system
- Open Payments Program
- Medicare Shared Savings Program
For More Information:
See the full text of this excerpted CMS Fact Sheet (Issued November 1).
- Final Rule
- Press Release
- Press Release – Treatment for Opioid Use Disorder
- Quality Payment Program Fact Sheet
- Register for November 6 Call
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