Multiple procedure payment reduction
Medicare applies a MPPR to the payment of select therapy services. The reduction applies to HCPCS codes contained on the list of...
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New Fiscal Intermediary Shared System (FISS) consistency edit to validate attending physician NPI
Effective April 1, CMS implemented a new consistency edit to validate the attending physician NPI. Claims are returning with...
Resolve claim return reason code 34963 for outpatient therapy services
Are you providing outpatient therapy services on institutional claims and receiving reason code 34963 indicating the attending...
Critical care services
CMS has new guidelines for critical care services effective January 1, 2022. These updates were implemented February 15, and...
Payment of codes for chemotherapy administration and nonchemotherapy injections and infusion
CMS provided clarification regarding the Medicare guidance relating to complex administration CPT codes 96401-96549. Please read...
Process for CPT category III T codes
Review the revised listing of CPT category III T codes that require documentation to avoid negative impacts to your claims.
Prohibition on billing dually eligible individuals enrolled in the Qualified Medicare Beneficiary (QMB) program
This article provides guidance to avoid inappropriately billing Qualified Medicare Beneficiaries (QMBs) for Medicare cost...
National Correct Coding Initiative (NCCI)
The National Correct Coding Initiative (NCCI) was developed to promote national correct coding methodologies and to control...
Do not report more than one unit per date of service for E/M codes
Avoid claim rejects. If you bill E/M codes within the CPT code range 99202-99239, do not report more than one unit per date of...
Allowing electronic submission of medically denied cancel claims
To determine if a claim was medically reviewed, providers should submit the requests correctly.