Awareness : Compliance Publications/Updates

Evaluation and Management Guidelines

The provider must ensure that medical record documentation supports the level of service reported to a payer.
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Florida House Bill 1175 Healthcare Transparency in Healthcare

The bill increases the transparency and availability of health care pricing and quality of service information to enable consumers to make informed choices regarding health treatment.
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Documentation is Required When Billing Modifier 24

For claims containing modifier 24 received on or after April 16, 2016, First Coast began developing to the provider to provide supporting documentation that justifies the use of the 24 modifier. Providers must respond within the specified time-frame included in the development letter. Failure to submit the documentation timely may result in a claim denial.

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Complying with Documentation Requirements for Laboratory Services

The majority of improper payments for laboratory services identified by the Comprehensive Error Rate Testing (CERT) Program were due to insufficient documentation.

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Medicare Reimbursement of Emergency Health Services Furnished to Undocumented Aliens Fact Sheet

This fact sheet informs ambulance services, hospitals including Critical Access Hospitals (CAHs), physicians, and Indian Health Service (IHS) facilities in specific states that funds remain available for certain emergency health services provided to undocumented aliens. As of February 2013, the Section 1011 program disbursed $945.5 million in provider payments in response to over 1.5 million payment requests.

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Medicare Advanced Beneficiary Notice (ABN)

The Centers for Medicare & Medicaid Services (CMS) implemented the Advanced Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131.  This booklet provides information to help providers and suppliers understand the Medicare requirements for when and how to issue an ABN.

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Medicare Immunization Billing Fact Sheet

The “Quick Reference Information: Medicare Immunization Billing” Fact Sheet (ICN 006799) was revised and is now available in downloadable format. This educational tool is designed to provide education on Medicare-covered preventive immunizations. It includes coverage, coding and billing information on the influenza, pneumococcal and Hepatitis B vaccines and their administration.

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Medicaid/AHCA Supervision Rules

Personal supervision means that the services are furnished whle the supervising practitioner is in the building and that the supervising practitioner signs and dates the medical records within 24 hours of the provision of the service.

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8 Digit Clinical Trial Number on Claims

CMS recently issued an Manual Instruction and an accompanying MLN Article, for Mandatory Reporting of an 8-Digit Clinical Trial Number on Claims.  Effective January 1, 2014, claims for items and services related to Category A and B devices, or under a Coverage Evidence Development (CED), must include the 8 digit number (always preceded by NCT on each study’s page) assigned by the National Library of Medicine at clinicaltrials.gov.

For detailed billing instructions, please review the CMS Manual System

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