Billing
Allowing electronic submission of medically denied cancel claims
To determine if a claim was medically reviewed, providers should submit the requests correctly.
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 34554 if modifier ER, PO, or PN is billed on all service lines, and…
Understanding radiopharmaceutical fee schedule amounts and billing expectations
Read this clarification regarding how radiopharmaceutical payment limits should be interpreted and how providers are expected to bill for these items.
First Coast supports Part B billing awareness during the month of June
Keep the momentum going -- navigate Part B post-payment claim scenarios! Attend the Medicare Navigator Part B Billing series and gain the tools to submit compliant redeterminations, correct claims…
Cardiac and pulmonary rehabilitation programs
Medicare pays for cardiac rehabilitation (CR), intensive cardiac rehabilitation (ICR), and pulmonary rehabilitation (PR) programs if specific criteria are met. These criteria include coverage…
Crossover claims: Supplemental insurance and Medigap plans
Read this article for more information on claims being crossed over to supplemental insurance and Medigap plans.
End-stage renal disease (ESRD) billing requirements
Read the following article for the most common billing requirements for end-stage renal disease related services.
Skilled nursing facility (SNF) demand bill
Read this article to learn more about skilled nursing facility (SNF) demand billing.
End stage renal disease (ESRD): Payment for phosphate binders effective January 1
Phosphate binders are paid as a renal dialysis service under Medicare Part B. Read this article to learn more.