The Centers for Medicare & Medicaid Services (CMS) requires all Medicare Advantage (MA) organizations to provide general compliance and fraud, waste, and abuse (FWA) training to all of its first tier, downstream and/or related entities (FDRs).
Effective May 1, 2017, PacificSource will no longer accept provider-based billing of office services, regardless of the office location. We will deny as noncovered any office services billed on a UB claim form, and you will need to resubmit them in the correct format.
Please be aware of the Interim instructions for billing this item. As this code will be billed with an unlisted HCPC code of E1399, PacificSource will require an invoice at the time of billing.
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.