Frequently Asked Questions

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Top Questions

What is an IRS Form CP 575?
The IRS Form CP 575 is an Internal Revenue Service generated letter you receive from the IRS granting your Employer Iden... (more)

What is the definition of "new patient" for billing evaluation and management (E/M) services?
Interpret the phrase "new patient" to mean a patient who has not received any professional services, i.e., evaluation an... (more)

How do I obtain the National Correct Coding Initiative (NCCI) Policy Manual?
The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services may be obtained through the CMS websit... (more)

What physician referral data sets are publicly available?
T... (more)

What is a Medically Unlikely Edit?
An MUE (Medically Unlikely Edit) is a unit of service (UOS) edit for a Healthcare Common Procedure Coding System (HCPCS)... (more)

How do I report medically reasonable and necessary units of service in excess of a Medically Unlikely Edit ...
For MUEs that are adjudicated as claim line edits, each line of a claim is adjudicated separately against the MUE value ... (more)

[EHR Incentive Programs] Who can enter medication orders in order to meet the measure for the computerized ...
Any licensed healthcare professional can enter orders into the medical record for purposes of including the order in the... (more)

[Medicare EHR Incentive Program]  When reporting on the Summary of Care objective in the Medicare and ...
CMS is aware of difficulties related to systems issues that eligible professionals, eligible hospitals, and critical ... (more)

What modifiers are allowed with the National Correct Coding Initiative (NCCI) edits?
The following modifiers are allowed with the National Correct Coding Initiative (NCCI) edits: Anatomic mod... (more)

[EHR Incentive Programs]  For meaningful use Stage 2's transitions of care and referrals objective, in...
An EP, eligible hospital, or CAH could use 3 distinct approaches (which could also be used in combination) to meet th... (more)

How do I report ICD-10 codes on claims when the dates of service span from prior to 10/1/2015 to on or afte...
Many payers are requiring claims with dates of service that span the October 1, 2015 implementation date to be split ... (more)

[EHR Incentive Programs] A number of measures for Meaningful Use objectives for eligible hospitals and crit...
There are two methods for calculating ED admissions for the denominators for measures associated with Meaningful Use ... (more)

How should eligible professionals select menu objectives for the Medicare Electronic Health Record (EHR) In...
Medicare eligible professionals participating in Stage 1 of the EHR Incentive Programs are required to report on a to... (more)

What exactly does "column 1" mean in the column 1/column 2 correct coding edits table?
Formerly known as the "comprehensive code" within the column 1/column 2 correct coding edits table, the column 1 code ge... (more)

How do I enroll in Medicare?
Providers can enroll in Medicare by using either Internet-based PECOS located at ... (more)

What procedures and services are payable when performed in the Ambulatory Surgical Center (ASC) setting und...
Under the ASC payment system, Medicare will make facility payments to ASCs only for the specific ASC covered surgical pr... (more)

[EHR Incentive Program]  Will the Centers for Medicare & Medicaid Services (CMS) conduct audits as...
Any provider attesting to receive an EHR incentive payment for either the Medicare or Medicaid EHR Incentive Program ... (more)

[EHR Incentive Programs]  When meeting the meaningful use measure for computerized provider order entr...
If a staff member of the eligible provider is appropriately credentialed and performs similar assistive services as a... (more)

[EHR Incentive Programs] In order to receive payments under the Medicare and Medicaid Electronic Health Rec...
In order to receive Medicare EHR incentive payments, EPs, eligible hospitals, and critical access hospitals must have... (more)

What can I do to avoid the Physician Quality Reporting System payment adjustment?
Beginning in 2015, CMS will subject eligible professionals who are not successful reporters under Physician Quality R... (more)

How do I know if I have a PECOS Record?
There are three (3) ways to verify that you have an enrollment record in PECOS:  Check the Ordering and Referrin... (more)

If a payer/pharmacy requires a diagnosis code for a prescription and the prescriber reports an ICD-9 diagno...
When conducting a standard transaction, medical data code sets (ICD-9 and ICD-10) that are valid at the time that the se... (more)