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Billing news

Modified: 9/9/2022
This article informs you and your vendors about changes that will allow you to request reopening of claims electronically.
Modified: 11/14/2022
Important information you should know before billing J9035 for Avastin (bevacizumab).
Modified: 11/13/2022
Based on claims reviewed by the recovery audit contractor (RAC), First Coast has identified top denials for services within the category of vein ablation (codes 36475 and 36478) relating to endovenous radiofrequency ablation and laser treatment for lower extremity varicose veins. Common findings indicate that medical necessity and documentation requirements are often not supported within the medical records submitted.
Modified: 11/3/2022
First Coast would like to ensure providers performing biopsy services understand how to properly bill and code for these procedures. Recent data indicates improper billing so we want to provide clarification of top issues we identified.
Modified: 10/28/2022
This article will assist Medicare Part B providers with proper billing relating to COVID-19 vaccine and monoclonal antibody infusion. Beneficiary coinsurance and deductible are waived.
Modified: 10/27/2022
This article will assist Medicare Part A providers with proper billing relating to COVID-19 vaccine and monoclonal antibody infusion. Beneficiary coinsurance and deductible are waived.
Modified: 10/22/2022
First Coast reminds providers that CMS updated MLN12124, which was initially released in March 2021, addressing NCD 90.2, Next Generation Sequencing (NGS), and the expiration of certain ICD-10 codes.
Modified: 10/20/2022
Important reminders when billing CPT codes 0596T and 0597T to avoid claim processing delays
Modified: 10/14/2022
CMS has issued the 2023 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service program. [MM12903]
Modified: 10/7/2022
Avoid ambulatory surgery center (ASC) claim denials for incorrect coding and documentation issues with CPT code 15823. Read more about proper billing for this service.
Modified: 10/6/2022
Medicare providers – please view this notice concerning unsolicited/voluntary refunds for 2021
Modified: 10/3/2022
Please review this reminder for billing the new condition codes (CCs) 90 and 91 issued by CMS under MM12049. First Coast revised this article to correctly reflect the effective date as claims received on or after February 1, 2021.
Modified: 10/3/2022
CMS created the new HCPCS code C9507 for COVID-19 convalescent plasma for use in the outpatient setting. Review this article for billing information.
Modified: 10/3/2022
Learn how to check a patient’s eligibility prior to submitting your COVID-19 laboratory test claims. Data shows an increase in Part B denials due to a patient’s inpatient status.
Modified: 10/1/2022
To determine if a claim was medically reviewed, providers should look at certain fields on the claim screen. [Provider Outreach and Education]
Modified: 9/30/2022
Data indicates that many providers are not submitting proper diagnosis codes to support the medical necessity for tetanus vaccinations.
Modified: 9/29/2022
Important information you must know when billing for Eylea (aflibercept) injections, J0178
Modified: 9/29/2022
Review this article for guidance on billing the home administration code M0201 when administering the COVID-19 vaccine.
Modified: 9/29/2022
Are your claims being impacted because you have multiple PTANs linked to a single NPI? This article provides guidance for improving the efficiency of the NPI selection and may assist Medicare Part B providers with billing COVID-19 related services.
Modified: 9/29/2022
This article provides guidance for NPI selection on claims and how to improve the efficiency of the NPI selection.
Modified: 9/20/2022
Review our series on billing alerts for the COVID-19 related services. This article was modified January 5 to address claim submission in 2022 for Medicare Advantage beneficiaries.
Modified: 9/16/2022
Reminder regarding correct reporting of micro or minimally invasive glaucoma surgery (MIGS)
Modified: 9/16/2022
Are you sending hardcopy mail to submit your requests to First Coast? Avoid the wait. There are faster and easier ways to send your requests to us. Learn about the electronic options available for you.
Modified: 9/11/2022
Learn about First Coast's electronic submission options.
Modified: 9/11/2022
Learn about First Coast's electronic submission options.
Modified: 9/9/2022
changed date in text to 2021
Modified: 9/8/2022
Avoid claim denials for leadless pacemakers, HCPCS codes 0387T-0391T. Read more about proper billing for these services.
Modified: 9/7/2022
Important information you should know before billing the compounded form of Avastin.
Modified: 9/6/2022
This article will assist providers with proper billing relating to the new monkeypox vaccine and laboratory codes. Note: This article was updated September 6 to advise providers to include the product code on claims.
Modified: 9/6/2022
Effective June 21, both the standard and expedited PAR coversheets are updated with new fields to improve the prior authorization request (PAR) process. The new fields include the facility fax number, the physician fax number, and a field relating to the implanted spinal neurostimulator.
Modified: 9/5/2022
How to bill for skin substitute coes A2001-A2010
Physicians and non-physician practitioners who perform procedure codes CPT 15271-15278 (application of skin substitute) may bill separately for skin substitute codes A2001-A2010.
Modified: 9/3/2022
This information outlines the process for the 935 recoupment.
Modified: 9/3/2022
Important information you must know when billing for Prolia® (denosumab) injections, J0897.
Modified: 9/3/2022
Read the following article for the most common billing requirements for end-stage renal disease related services.
Modified: 9/3/2022
This article is a reminder for all outpatient claim submitters about how to correctly submit the date of service on the claim.
Modified: 9/1/2022
View this article on billing for the drug Romidepsin for dates of service on or after July 1, 2021.
Modified: 8/26/2022
View this new page to easily locate information related to drugs and biologicals, such as billing and coding guidelines, related policy information, IOMs, and resources.
Modified: 8/26/2022
Medical documentation from ordering physicians plays a vital role in validating medical necessity of ordered laboratory tests.
Modified: 7/11/2022
Important information you must know when documenting and billing for MPI PET studies, 78491 and 78492, and Rb-82 rubidium tracer code, A9555.
Modified: 7/8/2022
This article provides information regarding unsolicited/voluntary refunds; that is, monies received by Medicare not related to an open account receivable.
Modified: 7/6/2022
This article assists with billing requirements for cochlear implant batteries L8621-L8624.
Modified: 7/6/2022
Effective October 1, First Coast will reject claims returned to a provider more than three times with reason code 70RTP. Read this article to learn more about this new reason code.
First Coast will reject claims returned to a provider more than three times with reason code 70RTP. Read this article to learn more about this new reason code.
Modified: 7/1/2022
The interest period begins on the day after payment is due and ends on the day of payment. The new rate of 4.00 percent is in effect July through December 2022. [Publication 100-04, Chapter 1, Section 80.2.2]
Modified: 6/23/2022
Most services billed to Medicare must reflect the exact date the service was performed for or provided to the patient. This article discusses situations where there have been questions from the provider community. [SE17023]
Modified: 6/16/2022
Are you submitting claims with procedure codes that aren't valid for Medicare? First Coast returns these claims to providers. Read this article to learn more about unprocessable claims.
Modified: 6/15/2022
Services designated as “inpatient only” are not appropriate to be furnished in a hospital outpatient department.
Modified: 1/6/2022
This article is a reminder for all inpatient claim submitters about how to correctly submit the date of service on the claim.
Modified: 12/1/2021
CMS has issued the 2022 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service program. [MM12507]
Modified: 10/15/2021
Providers billing Medicare should determine if a patient is enrolled in hospice before billing Medicare Part A. This article has tips on checking patient eligibility and avoiding hospice claim rejects.
Modified: 9/24/2021
Avoid claim rejects. If you bill E/M codes within the CPT code range 99201-99239, do not report more than one unit per date of service.
Modified: 9/15/2021
CMS has identified a claims processing issue that potentially impacts all Cohort 1 Primary Care First (PCF) participants that submitted claims for flat visit fee (FVF) eligible services processed between January 1, 2021, and February 3, 2021.
Modified: 8/16/2021
Effective for dates of service (DOS) on/after August 7, 2019, Medicare will pay claims from approved providers for administration of autologous T-cells expressing at least one CAR for the treatment for cancer using administration HCPCS code 0540T. [MM12177]
Modified: 7/20/2021
Documentation is required to process claims for ventricular assist device (VAD) supplies. View this article regarding how to avoid delays when billing VAD supplies.
Modified: 3/10/2021
CMS has issued the 2021 deductibles, coinsurance, and premium rates for beneficiaries covered through the Medicare fee-for-service program. [MM12024]
Modified: 3/4/2021
Modified: 2/11/2021
There are two options for providers to find information about a beneficiary’s deductible.
Modified: 12/15/2020
Transmittal 10486, dated November 19, 2020, is being rescinded and replaced by transmittal 10520, dated December 14, 2020, to revise the implementation date from December 14, 2020, to December 21, 2020. All other information remains the same. [CR11642]
Modified: 11/14/2020
Medicare claims processing systems will accept HCPCS code U0001 on April 1, 2020, for dates of service on or after February 4, 2020.
Modified: 9/9/2020
Learn which modifier to use when you expect Medicare will deny a claim that does not meet medical necessity criteria and whether you have or do not have an advanced beneficiary notice (ABN) signed by the beneficiary.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.