Fast facts: Appealing a CERT review decision
The Comprehensive Error Rate Testing (CERT) review contractor conducts a medical review of randomly sampled post-payment claims...
Articles
Article Type
Category
Fast facts: Responding to CERT additional documentation requests
Read this article for information about responding to CERT documentation requests.
MLN Connects for June 25, 2026
This edition includes information on the PEPPER relaunch, understanding the telehealth enrollment guide, preventing claim...
Utilizing modifier 91: Repeat clinical laboratory tests
View this article for instructions on how and when to use modifier 91.
How to bill correctly for transcranial magnetic stimulation (TMS) in the treatment of adults with major depressive disorder
First Coast is receiving first-level appeals (redeterminations) based on claim denials for providers not including the ordering...
Hospital off-campus outpatient department reporting requirements
Effective July 6, 2026, outpatient claims with type of bills (TOB) 13X or 14X will be returned to provider (RTP) for reason code...
Inappropriate billing of anesthesia services for epidural steroid injections (ESI) and facet joint injections for pain management
The Office of Inspector General (OIG) conducted a nationwide audit identifying Medicare Part B payments to physicians for...
Targeted probe and educate (TPE) round results: Evaluation and management services – initial and subsequent inpatient care visits
Review the top denial / partial denial reasons and high-level results of evaluation and management services - initial inpatient...
Credit balance reporting
Details on submitting the credit balance report, submission deadlines, and a tool to check credit balance status.