Thursday, April 3, 2025
News
- Home Infusion Therapy & Intravenous Immune Globulin Services: Get Monitoring Reports
- Medicare Providers & Suppliers: Report Managing Employees
- External User Services Help Desk: New Contact Information
- Advanced Primary Care Management Services: Get Information about Billing Medicare
Claims, Pricers & Codes
MLN Matters® Articles
News
Home Infusion Therapy & Intravenous Immune Globulin Services: Get Monitoring Reports
Read the February 2025 monitoring reports on these services:
- Home infusion therapy (PDF):
- Utilization for service visits
- Characteristics of users and supplier organizations
- Home intravenous immunoglobulin (IVIG) (PDF):
- Number of beneficiaries with claims that included a primary immunodeficiency disease diagnosis
- Utilization of home IVIG drugs and visits
- Characteristics of home visit recipients and supplier organizations
See Home Infusion Therapy & Home IVIG Services for more information.
Medicare Providers & Suppliers: Report Managing Employees
You must report all current managing employees on your Medicare enrollment application, or we may deactivate your enrollment.
You can make updates by:
- Submitting an 855 enrollment application in PECOS
- Mailing a paper application to your Medicare Administrative Contractor (MAC) or DME National Provider Enrollment Contractor (NPE) (PDF)
Managing employees are general managers, business managers, administrators, directors, or other individuals who exercise operational or managerial control or directly or indirectly conduct day-to-day operations.
While not an exhaustive list, these roles qualify as managing employees: Chief Executive Officer, Chief Operating Officer, Chief Financial Officer, Compliance Officer
- Regional Manager, Clinical Manager, Operations Manager, Care Coordination Manager, Location Manager, Administration Manager
- Compliance Director, Clinical Director
Contact your MAC or NPE if you’re unsure if an individual meets the definition.
To learn more, see the Medicare Program Integrity Manual, Chapter 10 (PDF).
External User Services Help Desk: New Contact Information
The External User Services (EUS) Help Desk website has a new URL and contact information:
- Website: https://eus.cms.gov
- Email: EUS_Support@cms.hhs.gov
- Phone: 866-484-8049
EUS supports:
- Identity & Access Management System
- PECOS
- NPPES
- Provider Statistical & Reimbursement System/ System for Tracking Audit and Reimbursement
- Medicare Exclusion Database
- CMS Preclusion List
The hours of operation are Monday – Friday from 7 am – 7 pm ET.
Advanced Primary Care Management Services: Get Information about Billing Medicare
Advanced Primary Care Management (APCM) Services combine elements of several existing care management and communication technology-based services you may have already been billing for your patients. Starting January 1, 2025, you may use a new payment bundle that reflects the essential elements of advanced primary care, including:
- Principal care management: disease-specific services to help manage a patient’s care for a single, complex chronic condition that puts them at risk of hospitalization, physical or cognitive decline, or death
- Transitional care management
- Chronic care management
Get answers to these questions:
- What are APCM services?
- Who can bill and how often?
- What are the HCPCS codes and billing requirements?
- Can auxiliary personnel provide APCM services?
- Where can I get more information?
Claims, Pricers & Codes
Lower Limb Orthoses: Prevent Claim Denials
In 2023, the improper payment rate for lower limb orthoses was 36.6%, with a projected improper payment amount of $92 million (see 2023 Medicare Fee-for-Service Supplemental Improper Payment Data (PDF), Appendix D). Learn how to bill correctly for these services. Review the Lower Limb Orthoses provider compliance tip for more information, including:
- Billing codes
- Denial reasons and how to prevent them
- Billing and coding criteria
- Example of improper payments due to insufficient documentation
- Resources
MLN Matters® Articles
Rural Health Clinic & Federally Qualified Health Center Medicare Benefit Policy Manual Update
Learn about updates (PDF), including:
- Changes to the Medicare Benefit Policy Manual, Chapter 13 (PDF)
- Revisions clarifying existing policy
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