evekhm/cms_iom_500 huggingface dataset:
(Medicare National Coverage Determinations Manual)
The HBV produces three separate antigen (surface, cores and e (envelope) antigens) when it infects the liver, although only hepatitis B surface antigen (HBsAg) is included as part of this panel.  Following exposure, the body normally responds by producing antibodies to each of these antigens; one of which is included in this panel: hepatitis B surface an tibody (HBsAb) -IgM antibody, HBsAg is the earlier marker, appearing in serum four to eight weeks after exposure, and typically disappearing within 6 months after its appearance.  If HBsAg remains detectable for greater than 6 months, this indicates chronic  HBV infection.  HBcAb, in the form of both IgG and IgM antibodies, are next to appear in serum, typically becoming detectable 2- 3 months following exposure.  The IgM antibody gradually declines or disappears entirely 1 -2 years following exposure, but the IgG usually remains detectable for life.  Because HBsAg is present for a relatively short period and usually displays a low titer, a negative result does not exclude and HBV diagnosis.  HBcAb, on the other hand, rises to a much higher titer and remain elev ated for a longer period of time, but a positive result is not diagnostic of acute disease, since it may be the result of a prior infection.  The last marker to appear in the course of a typical infection is HBsAb, which appears in serum 4 -6 months followi ng exposure to infected blood or body fluids; in the U.S., sexual transmission accounts for 30- 60 percent of new cases of HBV infection.
(Medicare National Coverage Determinations Manual)
The diagnosis of acute HBV infection is best established by documentation of positive IgM antibody against the core antigen (HBcAb -IgM) and by identification of a positive hepatitis B surface antigen (HBsAg).  The diagnosis of chronic HBV infection is established primarily by identifying a positive hepatitis B surface antigen (HBsAg) and demonstrating positive IgG antibody directed against the core antigen (HBcAb -IgG).  Additional tests such as hepatitis B e antigen (HBeAg) and hepatitis B e antibody (HBeAb), the envelope antigen and antibody, are not included in the hepatitis panel, but may be of importance in asse ssing the infectivity of patients with HBV.  Following completion of a HBV vaccination series, HBsAB alone may be used monthly for up to 6 months, or until a positive result is obtained, to verify an adequate antibody response.  HCV is the most common caus e of post -transfusion hepatitis; overall HCV is responsible for 15- 20 percent of all cases of acute hepatitis, and is the most common cause of chronic liver disease.  The test most commonly used to identify HCV measures HCV antibodies, which appear in blood 2- 4 months after infection.  False positive HCV results can occur.  For example, a patient with a recent yeast infection may produce a false positive anti -HCV result.  For this reason, at present positive results usually are confirmed by a more specific technique.  Like HBV, HCV is spread exclusively through exposure to infected blood or body fluids.  This panel of tests is used for differential diagnosis in a patient with symptoms of liver disease or injury.  When the time of exposure or the stage of the  disease is not known, a patient with continued symptoms of liver disease despite a completely negative hepatitis panel may need a repeat panel approximately 2 weeks to 2 months later to exclude the possibility of hepatitis.  Once a diagnosis is establishe d, specific tests can be used to monitor the course of the disease.   Indications   1. To detect viral hepatitis infection when there are abnormal liver function test results, with or without signs or symptoms of hepatitis.   2. Prior to and subsequent to liver tra nsplantation.   Limitations   After a hepatitis diagnosis has been established, only individual tests, rather than the entire panel, are needed.
(Medicare National Coverage Determinations Manual)
2. Prior to and subsequent to liver tra nsplantation.   Limitations   After a hepatitis diagnosis has been established, only individual tests, rather than the entire panel, are needed.   190.34 - Fecal Occult Blood Test  (Rev. 17, Issued: 07- 02-04) (Effective/Implementation: Not Applicable) PM AB 02 -110  The fecal occult blood test (FOBT) detects the presence of trace amounts of blood in stool.  The procedure is performed by testing one or several small samples of one, two or three different stool specimens.  This test may be performed with or without evidence of iron deficiency anemia, which may be related to gastrointestinal blood loss.  The range of causes for blood loss include inflammatory causes, including acid- peptic disease, non- steroi dal anti -inflammatory drug use, hiatal hernia, Crohns disease, ulcerative colitis, gastroenteritis, strongyloides, ascariasis, tuberculosis, and enteroamebiasis.  Vascular causes included angiodysplasia, hemangiomas, varices, blue rubber bleb nevus syndrome, and watermelon stomach.  Tumors and neoplastic causes include lymphoma, leiomyosarcoma, lipomas, adenocarcinoma and primary and secondary metastases to the GI tract.  Drugs such as nonsteroidal anti -inflammatory drugs also cause bleeding.  There are ex tra gastrointestinal causes such as hemoptysis, epistaxis, and oropharyngeal bleeding.  Artifactual causes include hematuria, and menstrual bleeding.  In addition, there may be other causes such as coagulopathies, gastrostomy tubes or other appliances, factitial causes, and long distance running.   Three basic types of fecal hemoglobin assays exist, each directed at a different component of the hemoglobin molecule.  1. Immunoassays recognize antigenic sites on the globin portion and are least affected by diet o r proximal gut bleeding, but the antigen may be destroyed by fecal flora.
(Medicare National Coverage Determinations Manual)
2. The heme- porphyrin assay measures heme -derived porphyrin and is least influenced by enterocolic metabolism or fecal storage.  This assay does not discriminate dietary from endogenous heme.  The capacity to detect proximal gut bleeding reduces its specificity for colorectal cancer screening but makes it more useful for evaluating overall GI bleeding in case finding for iron deficiency anemia.   3. The guaiac -based test is the most widely used.  It requires the peroxidase activity of an intact heme moiety to be reactive.  Positivity rates fall with storage.  Fecal hydration such as adding a drop of water increases the test reactivity but also increases false positivity.   Of these three test s, the guaiac- based test is the most sensitive for detecting lower bowel bleeding.  Because of this sensitivity, it is advisable, when it is used for screening, to defer the guaiac- based test if other studies of the colon are performed prior to the test.  Similarly, this tests sensitivity may result in a false positive if the patient has recently ingested meat.  Both of these cautions are appropriate when the test is used for screening, but when appropriate indications are present, the test should be done despite its limitations.   Indications   1. To evaluate known or suspected alimentary tract conditions that might cause bleeding into the intestinal tract.   2. To evaluate unexpected anemia.   3. To evaluate abnormal signs, symptoms, or complaints that might be associated with loss of blood.  4. To evaluate patients complaints of black or red -tinged stools.  Limitations   1. The FOBT is reported once for the testing of up to three separate specimens (comprising either one or two tests per specimen).   2. In patients who are  taking non- steroidal anti- inflammatory drugs and have a history of gastrointestinal bleeding but no other sign, symptoms, or complaints associated with gastrointestinal blood loss, testing for occult blood may generally be appropriate no more than once ev ery 3 months.  When testing is done for the purpose of screening for colorectal cancer in the absence of signs, symptoms, conditions, or complaints associated with gastrointestinal blood loss, report he HCPCS code for colorectal cancer screening; fecal -occult blood test, 1- 3 simultaneous determinations) should be used.
(Medicare National Coverage Determinations Manual)
Transmittals Issued for this Chapter
(Medicare National Coverage Determinations Manual)
Rev #  Issue Date  Subject  Impl Date  CR#  R12112NCD  06/29/2023  Technical Revisions Only to the National Coverage Determination (NCD) Manual, Publication (Pub) 100 -03 07/31/2023  13220  R11892NCD  03/09/2023  Technical Revisions Only to the National Coverage Determination (NCD) Manual  04/10/2023  13105  R11426NCD  05/20/2022  An Omnibus CR Covering: (1) Removal of Two National Coverage Determination (NCDs), (2) Updates to the Medical Nutrition Therapy (MNT) Policy, and (3) Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitat ion (ICR) Conditions of Coverage  07/05/2022  12613  R11272NCD  02/18/2022  An Omnibus CR Covering: (1) Removal of Two National Coverage Determination (NCDs), (2 ) Updates to the Medical Nutrition Therapy (MNT) Policy, and (3) Updates to the Pulmonary Rehabilitation (PR), Cardiac Rehabilitation (CR), and Intensive Cardiac Rehabilitation (ICR) Conditions of Coverage- Rescinded and replaced by Transmittal 11426  07/05 /2022  12613  R181NCD  03/27/2015  Removal of Multiple National Coverage Determinations Using Expedited Process  04/06/2015  9095  R180NCD  03/06/2015  Removal of Multiple National Coverage Determinations Using Expedited Process  Rescinded and replaced  by Transmittal 181 04/06/2015  9095  R173NCD  09/04/2014  Pub 100 -03, Chapter 1, Language -only Update Upon Implementation of ICD -10 8506  R159NCD  02/05/2014  Pub 100 -03, Chapter 1, Language -only Update  Rescinded and replaced by Transmittal 173  10/01/2014  8506  R131NCD  02/23/2011  Screening for the Human Immunodeficiency Virus (HIV) Infection  07/06/2010  6786  R118NCD  03/23/2010  Screening for the Human Immunodeficiency Virus (HIV) Infection  Rescinded and replaced by Transmittal 131 07/06/2010  6786 R113NCD  02/19/2010  Screening for the Human Immunodeficiency Virus
(Medicare National Coverage Determinations Manual)
for the Human Immunodeficiency Virus (HIV) Infection  Rescinded and replaced by Transmittal 131 07/06/2010  6786 R113NCD  02/19/2010  Screening for the Human Immunodeficiency Virus (HIV) Infection - Rescinded and replaced by Transmittal 118 07/06/2010  6786  R90NCD  07/25/2008  Prothrombin Time (PT/INR) Monitoring for Home Anticoagulation Management  08/25/2008  6138  R55NCD  05/05/2006  Changes Conforming to CR 3648 Instructions for Therapy Services  10/02/2006  4014  R48NCD  03/17/2006  Technical Corrections to the NCD Manual  06/19/2006  4278  R47NCD  02/24/2006  Changes to the Covered Indications for Tumor Antigen by Immunoassay CA 125 to Add Primary Peritoneal Carcinoma  01/03/2006  4257  R28NCD  02/11/2005  Update of Laboratory NCDs to Reference New Screening Benefits  03/11/2005  3690  R17NCD  07/02/2004  Manualization of the Negotiated Clinical Diagnostic Laboratory National Coverage Determinations  N/A 2130  R10NCD  04/06/2004  Re-release of NCD Manual  N/A N/A R01NCD  10/01/2003  Initial Release of Manual  N/A N/A Back to top of Chapter
1.1_PartA_Inpatient_120907.pdf
Medicare Summary Noticefor Part A (Hospital Insurance) The Official Summary of Your Medicare Claims from the Centers for Medicare & Medicaid ServicesYour Deductible StatusYour deductible is what you must pay each benefit period for most health services before Medicare begins to pay. Part A Deductible:  You have now met your $1,068.00 deductible for inpatient hospital services for the benefit period that began May 27, 2011.Be Informed!Register at www.MyMedicare.gov for direct access to your Original Medicare claims, track your preventive services and print an On the Go report to share with your provider. Visit the Web site to sign up and access your personal Medicare information.THIS IS NOT A BILLJENNIFER WASHINGTON  TEMPORARY ADDRESS NAMESTREET ADDRESSCITY, ST 12345-6789Notice for Jennifer WashingtonMedicare Number XXX-XX-1234ADate of This Notice September 16, 2011Claims Processed  BetweenJune 15   September 15, 2011Saba que puede recibir este aviso y otro tipo de ayuda de Medicare en espaol? Llame y hable con un agente en espaol.     agent ,  Mandarin .                   1-800-MEDICARE (1-800-633-4227)Your Claims & Costs This PeriodDid Medicare Approve All Claims? YESSee page 2 for how to double-check this notice.Total You May Be Billed $2,062.50Facilities with Claims This PeriodJune 18  June 29, 2011  Otero HospitalJuly 1  July 18, 2011  Lexington Health CenterPage 1 of 5Exhibit 1.1  Part A, InpatientTHIS IS NOT A BILL | Page 2 of 5 Jennifer WashingtonMaking the Most of Your Medicare  How to Check This NoticeDo you recognize the name of each facility?  Check the dates.Did you get the claims listed?  Do they match those listed on your receipts and bills? If you already paid the bill, did you pay the right amount?  Check the maximum you may be billed. See if the claim was sent to your Medicare supplement insurance (Medigap) plan or other insurer. That plan may pay your share.
1.1_PartA_Inpatient_120907.pdf
How to Report FraudIf you think a facility or business is involved in fraud, call us at 1-800-MEDICARE (1-800-633-4227).Some examples of fraud include offers for free medical services, or billing you for Medicare services you didnt get. If we determine that your tip led to uncovering fraud, you may qualify for a reward.You can make a difference!  Last year, Medicare saved tax-payers $4 billion the largest sum ever recovered in a single yearthanks to people who reported suspicious activity to Medicare.  How to Get Help with Your Questions1-800-MEDICARE (1-800-633-4227)  Ask for hospital services. Your customer-service code is 05535.TTY 1-877-486-2048 (for hearing impaired)Contact your State Health Insurance Program (SHIP) for free, local health insurance counseling. Call 1-555-555-5555 .  Your Benefit PeriodsYour hospital and skilled nursing facility (SNF) stays are measured in benefit days  and benefit periods . Every day that you spend in a hospital or SNF counts toward the benefit days in that benefit period. A benefit period begins the day you first receive inpatient hospital services or, in certain circumstances, SNF services, and ends when you havent received any inpatient care in a hospital or inpatient skilled care in a SNF for 60 days in a row. Inpatient Hospital: You have 56 out of 90 covered benefit days  remaining for the benefit period that began May 27, 2011.Skilled Nursing Facility: You have 63 out of 100 covered benefit days  remaining for the benefit period that began May 27, 2011.See your Medicare & You handbook for more information on benefit periods.
1.1_PartA_Inpatient_120907.pdf
Your Messages from MedicareGet a pneumococcal shot.  You may only need it once in a lifetime. Contact your health care provider about getting this shot. You pay nothing if your health care provider accepts Medicare assignment.To report a change of address , call Social Security at 1-800-772-1213. TTY users should call  1-800-325-0778.Early detection is your best protection.  Schedule your mammogram today, and remember that Medicare helps pay for screening mammograms. Do you use therapy services? Watch the limit! In 2011, Medicares annual coverage limit for most outpatient physical therapy and speech language pathology is $1,860 combined.Exhibit 1.1  Part A, InpatientJennifer Washington THIS IS NOT A BILL | Page 3 of 5Benefit  Days  UsedClaim  Approved?Non-  Covered  ChargesAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowBenefit Period starting May 27, 2011 1 day Yes $0.00 $6,583.00 $0.00Total for Claim #20906900033902 $0.00 $6,583.00 $0.00 APart A Inpatient Hospital Insurance helps pay for inpatient hospital care, inpatient care in a skilled nursing facility following a hospital stay, home health care, and hospice care. Definitions of ColumnsBenefit Days Used: The number of covered benefit days you used during each hospital and/or skilled nursing facility stay. (See page 2 for more information and a summary of your benefit periods.)  Claim Approved?: This column tells you if Medicare covered the inpatient stay.  Non-Covered Charges: This is the amount Medicare didnt pay. Amount Medicare Paid: This is the amount Medicare paid your inpatient facility.Maximum You May Be Billed: The amount you may be billed for Part A services can include a deductible, coinsurance based on your benefit days used, and other charges. For more information about Medicare Part A coverage, see your Medicare & You handbook.Your Inpatient Claims for Part A (Hospital Insurance)June 18  June 21, 2011Otero Hospital, (555) 555-1234  PO Box 1142, Manati, PR 00674Referred by Jesus Sarmiento ForastiJune 29, 2011Otero Hospital, (555) 555-1234  PO Box 1142, Manati, PR
1.1_PartA_Inpatient_120907.pdf
555-1234  PO Box 1142, Manati, PR 00674Referred by Jesus Sarmiento ForastiJune 29, 2011Otero Hospital, (555) 555-1234  PO Box 1142, Manati, PR 00674Referred by Carlos Santiago DiazBenefit  Days  UsedClaim  Approved?Non-  Covered  ChargesAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowBenefit Period starting May 27, 2011 4 days Yes $0.00 $4,886.98 $0.00Total for Claim #20905400034102 $0.00 $4,886.98 $0.00 AContinued   Notes for Claims AboveADays are being subtracted from your total inpatient hospital benefits for this benefit period. The Your Benefit Periods section on page 2 has more details.Exhibit 1.1  Part A, InpatientJennifer Washington THIS IS NOT A BILL | Page 4 of 5Benefit  Days  UsedClaim  Approved?Non-  Covered  ChargesAmount  Medicare  PaidMaximum  You May  Be BilledSee  Notes  BelowBenefit Period starting May 27, 2011 17 days Yes $0.00 $7,012.27 $2,062.50Total for Claim #21034400232702ILA $0.00 $7,012.27 $2,062.50 B,CJuly 1  July 18, 2011Lexington Health Center, (555) 555-1234  815e Irving Park Rd, Streamwood, IL 60107-3073Referred by Warren PierceNotes for Claims AboveBDays are being subtracted from your total skilled nursing facility benefits for this benefit period. The Your Benefit Periods section on page 2 has more details.C$2,062.50 was applied to your skilled nursing facility coinsurance.Exhibit 1.1  Part A, InpatientFile an Appeal in WritingFollow these steps:1Circle the service(s) or claim(s) you disagree with on this notice.2Explain in writing why you disagree with  the decision. Include your explanation on this notice or, if you need more space, attach a separate page to this notice.3Fill in all of the following:Your or your representatives full name (print)Your or your representatives signatureYour telephone numberYour complete Medicare number4Include any other information you have about your appeal. You can
1.1_PartA_Inpatient_120907.pdf
in all of the following:Your or your representatives full name (print)Your or your representatives signatureYour telephone numberYour complete Medicare number4Include any other information you have about your appeal. You can ask your facility for any information that will help you.5Write your Medicare number on all documents that you send.6Make copies of this notice and all supporting documents for your records.7Mail this notice and all supporting documents to the following address:Medicare Claims Office  c/o Contractor Name  Street Address  City, ST 12345-6789Get More DetailsIf a claim was denied, call or write the hospital or facility and ask for an itemized statement for any claim. Make sure they sent in the right information. If they didnt, ask the facility to contact our claims office to correct the error. You can ask the facility for an itemized statement for any service or claim.Call 1-800- MEDICARE  (1-800-633-4227) for more information about a coverage or payment decision on this notice, including laws or policies used to make the decision.If You Need Help Filing Your AppealContact us:  Call 1-800-M EDICARE  or your State Health Insurance Program (see page 2) for help before you file your written appeal, including help appointing a representative. Call your facility:  Ask your facility for any information that may help you.Ask a friend to help:  You can appoint someone, such as a family member or friend, to be your representative in the appeals process.Find Out More About AppealsFor more information about appeals, read your Medicare & You handbook or visit us online at www.medicare.gov/appeals.If You Disagree with a Coverage Decision, Payment Decision, or Payment Amount on this Notice, You Can Appeal Appeals must be filed in writing.  Use the form to the right. Our claims office must receive your appeal within 120 days from the date you get this notice. We must receive your appeal by:  January 14, 2011Jennifer Washington THIS IS NOT A BILL | Page 5 of 5How to Handle Denied Claims or File an Appeal Exhibit 1.1  Part A, InpatientPage 1 of 5Medicare Summary Noticefor Part A (Hospital Insurance) The Official Summary of Your Medicare Claims from the Centers for Medicare & Medicaid ServicesYour Deductible StatusYour deductible is what you must pay each benefit period for most health services
1.1_PartA_Inpatient_120907.pdf
Summary Noticefor Part A (Hospital Insurance) The Official Summary of Your Medicare Claims from the Centers for Medicare & Medicaid ServicesYour Deductible StatusYour deductible is what you must pay each benefit period for most health services before Medicare begins to pay. Part A Deductible:  You have now met your $1,068.00  deductible for inpatient hospital services for the benefit period that began May 27, 2011.Be Informed!Register at www.MyMedicare.gov for direct access to your Original Medicare claims, track your preventive services and print an On the Go report to share with your provider. Visit the Web site to sign up and access your personal Medicare information.THIS IS NOT A BILLJENNIFER WASHINGTON  TEMPORARY ADDRESS NAMESTREET ADDRESSCITY, ST 12345-6789Saba que puede recibir este aviso y otro tipo de ayuda de Medicare en espaol? Llame y hable con un agente en espaol.     agent ,  Mandarin .                   1-800-MEDICARE (1-800-633-4227)Your Claims & Costs This PeriodDid Medicare Approve All Claims? NONumber of Services Medicare Denied 2See claims starting on page 3. Look for NO in the Claim Approved? column. See the last page for how to handle a denied claim. Total You May Be Billed $2,062.50Facilities with Claims This PeriodJune 18  June 29, 2011  Otero HospitalJuly 1  July 18, 2011  Lexington Health CenterNotice for Jennifer WashingtonMedicare Number XXX-XX-1234ADate of This Notice September 16, 2011Claims Processed  BetweenJune 15   September 15, 2011Exhibit 1.1  Part A, Inpatient page 1 with denied claims