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Medicare billing guidelines

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Medicare updates its billing policies each year following the release of the annual final rule. The final rule often introduces and explains coding and billing changes (e.g., when to use the KX modifier or the new X modifiers) and reporting programs (e.g., the implementation of the Merit-Based Incentive Payment System (MIPS) and the death of functional limitation reporting (FLR)). Many billing rules participating Medicare providers must adhere to—blank—. However, some of the most prominent and often-talked about documentation and/or billing policies are:  

  • the eight-minute rule (i.e., the rule that determines how many units a provider can bill for a service)  
  • Advance Beneficiary Notices of Noncoverage (ABN) guidelines
  • supervision requirements
  • progress notes and POC recertification requirements

When it comes to actually completing and submitting claim forms, Part A requires the use of UB-04 forms, and Part B requires the use of CMS-1500 forms. Part C billing form requirements vary based on payer and state; Mississippi, for instance, requires the use of a specific, state-mandated form.