On August 6, 2015, Congress enacted the Notice of Observation Treatment and Implication for Care Eligibility (NOTICE) Act, which requires all Hospitals and Critical Access
Hospitals (CAHs) to provide written notification and an oral explanation of such notification to individuals receiving observation services as outpatients for more than 24 hours.
All outpatient claims submitted for reimbursement that contain drug-related codes must include the NDC number, quantity, and unit of measurement to be considered valid. This requirement applies to paper claim forms CMS-1500, UB-04, and Electronic Data Interface (EDI) transactions when billed for drug-related HCPC and CPT codes.
PacificSource Medicare will begin rejecting claims with missing or incomplete/invalid NDC information. Please click on the Read More below for more detailed information.
Urgent/Emergent Prior Authorization Requests
As a friendly reminder, most genetic testing requires a prior authorization. The ordering physician should be the responsible party for requesting the prior authorization for the testing.
Effective June 1st, 2016 the Durable Medical Equipment (DME) reimbursement in your contract will reference the 2016 CMS DMEPOS Rural fee schedule.
PacificSource will follow CMS guidelines for billing 99497 and 99498.
Effective 4/1/16 the Centers for Medicare & Medicaid Services (CMS) will require RHC's including those exempt from electronic reporting Section 424.32(d)(3), are required to report the appropriate HCPCS code for each service line along with the revenue code, and other required billing codes. Payment for RHC services will continue to made under the All-Inclusive Rate (AIR) system when all of the program requiremsnts are met. There is no change to the AIR system and payment
This fact sheet is being provided by the Centers for Medicare & Medicaid Services (CMS) to correct misinformation in the chiropractic community, relating to Medicare and its regulations as it relates to chiropractic services. This fact sheet is informational only and represents no changes to existing Medicare policy. CMS is providing this fact sheet in order to clarify specific issues.