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J15 HH&H FAQs

WEBThis product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software …

Actived: 9 days ago

URL: https://www.cgsmedicare.com/medicare_dynamic/faqs/faqshhh/display_faqs_j15HHH.aspx?id=116

Medically Necessary and Reasonable

WEBMedically Necessary and Reasonable. Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §20.1) All services billed to Medicare must meet the criteria of …

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Physician NPP Guide to Home Health

WEBJune 14, 2021. Physician NPP Guide to Home Health. A patient must meet the following five criteria to meet eligibility for home health services: Homebound Status: No …

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New Home Health Documentation Checklist Tool

WEBNew Home Health Documentation Checklist Tool. CGS has developed a new tool for home health clinical staff to use as a checklist of all the coverage criteria for the …

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DOCUMENTATION CHECKLIST TOOL

WEBDo the following data elements match the claim and OASIS assessment: Home health agency (HHA) Certification Number (OASIS item M0010) Beneficiary Medicare Number …

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Physician or Allowed Practitioner Orders, Plan of Care and …

WEBThree basic requirements for ordering services are: The physician or allowed practitioner must be enrolled in Medicare; The ordering National Provider …

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Self-Service Options

WEBSelf-Service Options. The following tools are designed for home health and hospice providers who submit claims to CGS. Disclaimer: CGS' online tools and calculators are …

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National and Local Coverage Determinations (NCDs and …

WEBNational and Local Coverage Determinations (NCDs and LCDs) An NCD sets forth the extent to which Medicare will cover specific services, procedures, or …

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Home Health Medicare Billing Codes Sheet

WEB38157, 38200. Duplicate billing transaction; adjust or cancel claim or RAP instead of resubmitting. 38107. Re-bill RAP if auto-cancel AND ensure RAP is in P B9997 AND …

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Timely Claim Filing Requirements

WEBTimely Claim Filing Requirements. Medicare Claims Processing Manual, Pub. 100-04, Ch. 1, §70. Home health and hospice billing transactions, including, claims, and …

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Intermittent, if Skilled Nurse

WEBIntermittent, if Skilled Nurse. Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.1.3) Intermittent skilled nursing care is a medically predictable, …

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Determining Homebound

WEBThe Centers for Medicare and Medicaid Services (CMS) released a clearer definition of homebound to be used when deciding if patients are eligible for home …

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Reason Code Descriptions and Resolutions

WEBReason Code 30995. Description: For services provided on or after January 1, 2020, the Medicare Beneficiary Identifier (MBI) must be submitted. With a few …

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Annual Wellness Visit (A/B MAC Jurisdiction 15)

WEBFirst annual wellness visit providing personalized prevention plan services means the following services furnished to an eligible beneficiary by a health professional that …

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Change Healthcare Security Incident

WEBFebruary 29, 2024 – Updated 04.09.24. Change Healthcare Security Incident. Update 03.07.24: On March 5, 2024, the U.S. Department of Health and Human Services (HHS) …

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Adjustments/Cancels

WEBCancel claims (type of bill XX8) may be necessary when the incorrect provider number was submitted, an incorrect Medicare ID number was submitted, or a …

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Hospice Medicare Billing Codes Sheet

WEBHCPCS Codes (FL 44) For Discipline Lines (42X, 43X, 44X, 55X, 56X, 57X) G0151: Physical therapy: G0152: Occupational therapy: G0153: Speech language pathology

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