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HCPro Store About Us Career Center Share Your Expertise HCPro is dedicated to providing the highest-quality, need-to-know information in revenue cycle management, hospital accreditation, nursing, long-term care, medical staff credentialing and privileging, medical coding and billing, and more. Healthcare Marketplace HealthLeaders Media Categories Accreditation Case Management Corporate Compliance Credentialing & Privileging Executive Leadership Health Information Management Home Health & Hospice Life Sciences Long-Term Care Managed Care Marketing Medical Staff Medicare Nursing Physician Practice Quality & Patient Safety Residency Revenue Cycle Safety Healthcare Headlines Top Stories Medicare Managed Care Appeals & Grievances Medicare health plans, which include Medicare Advantage (MA) plans – such as Health Maintenance Organizations, Preferred Provider Organizations, Medical Savings Account plans and Private Fee-For-Service plans – Cost Plans and Health Care Prepayment Plans, must meet the requirements for grievance and appeals processing under Subpart M of the Medicare Advantage regulations. For a detailed discussion of the Medicare managed care grievance and appeals processes, click here . Plans and providers have certain responsibilities related to notifying beneficiaries of Medicare appeal rights. If a Medicare health plan denies service or payment, in whole or in part, the plan is required to provide the enrollee with a written notice of its determination. Additionally, Medicare health plan enrollees receiving covered services from an inpatient hospital, skilled nursing facility, home health agency, or comprehensive outpatient rehabilitation facility have the right to a fast, or expedited, review if they think their Medicare-covered services are ending too soon . New Medicare cards offer greater protection to more than 57 million Americans New cards will no longer contain Social Security numbers , to combat fraud and illegal use The Centers for Medicare & Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars. The new cards will use a unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI), to replace the Social Security-based Health Insurance Claim Number (HICN) currently used on the Medicare card. CMS will begin mailing new cards in April 2018 and will meet the congressional deadline for replacing all Medicare cards by April 2019. Today, CMS kicks-off a multi-faceted outreach campaign to help providers get ready for the new MBI. Two-Midnight Rule: Initial Reviews to Resume Having taken time out for retraining and internal audits, contractors may resume initial-phase reviews of Medicare reimbursement claims for short-stay inpatient hospital care, CMS says. Q&A: Submitting claims for observation services Q: Did something change with the observation services Composite APC in 2016? The director of patient financial services says we no longer receive payment for it. Don't underestimate the importance of good documentation It’s an unfortunate part of healthcare today—the lawsuit. Are you ready if one is filed against your organization? Q&A: Should we hardcode modifier -CT? Q: Our radiology department is requesting that we add a new modifier to their charge description master (CDM), modifier –CT (computed tomography [CT] services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association [NEMA] XR-29-2013 standard). They want this added to the CT scan line items, but they are not sure if it is for all of the items or only certain ones. Can you provide more information that might help us know how to proceed? User Login Logging in allows you to read your e-Newsletter subscriptions and customize your HCPro experience. Login Help Username: Password: Remember Me WHAT'S THIS? Forgot Password? Partner with HCPro Find the training and revenue cycle information and tools you need to meet the unique needs of your clients. Our consultative approach and client success team provide the support you need grow your business with a true partnership. About Us | Blogs | Press Releases | Products | Advertise | Terms of Use | Privacy | Sitemap | Reprints/Permissions | Work for Us | Partnerships Contact Us HCPro 35 Village Road, Suite 200, Middleton , MA 01949 USA P : 1.800.650.6787 F : 1.800.785.9212 *MAGNET™, MAGNET RECOGNITION PROGRAM®, and ANCC MAGNET RECOGNITION® are trademarks of the American Nurses Credentialing Center (ANCC). The products and services of HCPro are neither sponsored nor endorsed by the ANCC. The acronym "MRP" is not a trademark of HCPro or its parent company. Copyright © 2020 HCPro, a Simplify Compliance brand. All rights reserved....