Medicare

Instructions for: Medicare Redetermination Request (Resource 241)

The Medicare Redetermination Request is the first step in the Medicare Appeals process.

After the initial determination and denial, the Redetermination review process is performed by your contractor. Your request must be submitted in written form. Your contractor generally makes a decision within 60 days from the timethey receive your request. This decision will be in the form of a letter, Medicare Summary Notice (MSN), or Remittance Advice (RA).

Of nearly 15,000 test claims received by the Centers for Medicare & Medicaid for the first round of end-to-end ICD-10 testing, 81 percent were accepted, according to statistics revealed by the agency Wednesday.

Medicare Resources (Resource 210)

For detailed information on this government program, as it relates to Behavioral Health services, see Section C-Medicare in the Behavioral Health DeskBook.

You need to understand the following concepts:

Government Healthcare Programs (Resource 162)

The Department of Health and Human Services (HHS) oversees all government health care programs. They are administered by various agencies such as the Centers for Medicare & Medicaid Services (CMS), the Veterans Administration (VA) and even at the state level. Here are the basic government programs:

EHR Hardship Exemption

The following information is from the Centers for Medicare & Medicaid Services (CMS) regarding the Electronic Health Records (EHR) payment reduction hardship exemption:

    Hardship Exceptions for Medicare EPs

Testing & Screening Tools (Resource 284)

There are numerous types of behavioral health screening tools available for healthcare providers. This page includes some general information and resources for some of these screening tools. Let us know if you would like others included here as well.

AUDIT - Alcohol Use Disorders Identification Test

10 Question survey - can be done as interview or as patient completed questionaire.

The MLN Connects Provider eNews for February 5, 2015 included the following notice:

CMS Intends to Engage in Rule making for EHR Incentive Program Changes for 2015

If you are an eligible professional participating in the Medicare EHR Incentive Program, you have until February 28, 2015 to attest to demonstrating meaningful use of the data collected during your EHR reporting period for the 2014 calendar year.

If you are an eligible professional participating in the Medicare EHR Incentive Program, you have until February 28, 2015 to attest to demonstrating meaningful use of the data collected during your EHR reporting period for the 2014 calendar year.

40-Effect of Beneficiary Agreements Not to Use Medicare Coverage

(Rev. 160, Issued: 10-26-12, Effective: 01-28-13, Implementation: 01-28-13)

(Rev. 194, 09-03-14)

 

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