Article Detail - JE Part A

Wouldn’t it be nice to start the New Year right, and have fewer appeals? Follow the tips below and spend less time filing appeals and more time doing other tasks.

• Check Noridian’s reopening page to determine what can be done as a reopening
• Do not file claims more than once
  • Wait for claim to process, and then complete reopening or appeal, if necessary
  • Ask billing service to not automatically rebill any claims.
• Attend Noridian webinars, or watch tutorials, to become familiar with medical necessity and appeals guidelines
  • JE Schedule of Events
  • JE Webinar on Demand Recordings
  • Noridian Medicare Part A & B - YouTube
• Communicate with outside providers
  • Send, or acquire, medical records (or advance beneficiary notice of non-coverage-ABN) at time of referral
  • Communicate with each other regarding who will bill
    • CMS requires provider performing work to bill, except certain circumstances
• Only appeal after 120 days with good cause
  • Unavoidable circumstances out of provider’s control - major floods, fires, tornadoes, and other natural catastrophes
  • Incorrect or incomplete information about claim or appeal furnished by official sources (CMS, contractor, or Social Security Administration)
  • For more information, review information on CMS’ website for more good cause examples
• Modifiers related to hospice
  • GV - Attending physician is not employed or paid under agreement by the patient's hospice provider
  • GW - Services unrelated to hospice condition