Hospice Billing and Eligibility Inquiry Notifications

Posted on Thursday, April 18, 2019 8:12 PM

CMS has issued Change Request 11042, which will update the Medicare Claims Processing Model, Chapter 29 – Appeal of Claim Decisions. 

The updates address: acceptable signatures, limiting the scope of redetermination review in specific cases, application of good cause for filing late and application of good cause when there is a declared disaster.

 Following are key revisions CMS has incorporated into the manual:

  • Adds the terms Medicare number, Medicare Beneficiary Identifier (MBI), and attorney adjudicator to the Glossary.
  • Includes throughout the chapter of the Medicare number which incorporates both the Health Insurance Claim Number (HICN) and the new MBI.
  • Requires the Medicare Administrative Contractors (MACs) to document good cause for late filing on the appeal decision letter or the appeal case file.
  • Instructs the MACs on procedures to follow for appeals when a natural or man-made disaster occurs.
  • Outlines policies for accepted forms of signatures.
  • Requires the MACs to toll the timeframe when attempting to cure a defective appointment instrument.
  • Provides guidance for the MACs in determining proper parties to an appeal when a beneficiary is incapacitated or in the case of a beneficiary’s death.
  • Updates policies for redeterminations

Source: NAHC Report

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