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 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)

How do I handle claims that span the ICD-10 implementation date?
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How do I access the ICD-10 code set?
You can access complete versions of both ICD-10-CM (diagnoses) and ICD-10-PCS (procedures), as well as the General Equiv... (more)

Does CMS require updated physician (or non-physician practitioner) orders for lab, radiology services,...
C... (more)

Can a claim contain both ICD-9-CM and ICD-10-CM/PCS codes?
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What qualifier do I use for ICD-10 diagnosis codes on electronic claims?
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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)

In current practice by the mental health field, many clinicians use the DSM-IV in diagnosing mental disorde...
Yes. It is expected that clinicians may continue to base their diagnostic decisions on the DSM-IV/DSM-5 criteria. In add... (more)

What physician referral data sets are publicly available?
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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)

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)

[EHR Incentive Programs]  When reporting on the Summary of Care objective in the Electronic Health Rec...
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[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 fo... (more)

Will my payment under ICD-10 be the same as the payment I currently receive under ICD-9?
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Using Condition code 44, how should the hospital report observation services when the patient's status is c...
The use of Condition Code 44 pertains to the entire patient encounter (from the beginning of the inpatient/outpatient en... (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)

[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)

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)

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

How should claims be handled when they are split for an outpatient encounter spanning the October 1, 2015, ...
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Will ICD-9-CM codes be accepted on claims with FROM dates of service or dates of discharge/THROUGH dates on...
No. ICD-9-CM codes will no longer be accepted on both electronic and paper claims with FROM dates of service (on profess... (more)

[EHR Incentive Programs] A number of measures for Meaningful Use objectives for eligible hospitals and crit...
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Who is affected by the transition to ICD-10; if I don't deal with Medicare claims, will I have to transition?
Everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) must transition to ICD-10. &nbs... (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)

What will happen to institutional, professional, and supplier claims that contain ICD-9-CM codes for servic...
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[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,... (more)

[EHR Incentive Programs] For the Health Information Exchange objective for meaningful use in 2015 through 2...
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[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)

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)

Will providers be able to use ICD-10-CM/PCS codes on claims prior to the October 1, 2015, implementation date?
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How were the ICD-9 codes translated to ICD-10 for national coverage determinations (NCD) and local co...
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How should I submit claims with Home Health (HH) episodes that span the ICD-10 implementation date?
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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 find information on a specific CMS policy or regulation?
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Will CMS allow for dual processing of ICD-9 and ICD-10 codes (accept and process both ICD-9 and ICD-10 cod...
No, CMS will not allow for dual processing of ICD-9 and ICD-10 codes after ICD-10 implementation on October 1, 2015. Man... (more)

What is the difference between a legacy provider identifier (LPI) and a National Provider Identifier (NPI)?...
LPIs are any of a known set of identifiers used by either states or the federal government to identify service providers... (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)

Can you explain how inpatient admissions are assigned to Medicare Severity Diagnosis Related Groups (MS-DR...
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When ICD-10-CM codes replace ICD-9-CM codes on October 1, 2015, will it impact how I report Current Proced...
No. When ICD-10-CM codes replace ICD-9-CM codes on October 1, 2015, it will not impact how you report Current Procedura... (more)

If patients have recurring appointments for physical therapy, occupational therapy, or speech-language path...
In cases where physician or qualified non-physician practitioner orders are applicable to rehabilitation services furnis... (more)

What are cross-cutting measures in Physician Quality Reporting System (PQRS) and how do face-to-face encoun...
Cross-cutting measures are any measures that are broadly applicable across multiple clinical settings and eligible pr... (more)