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.
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.
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.
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.
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.
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.
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.
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.
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.
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]
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]
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.
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.
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]
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]
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.