Claims

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Current processing issues

An update was made to a Part B issue reflecting pending claims are now finalized and payments started with the May 11 cycle.

Credit balance reporting

Details on submitting the credit balance report, submission deadlines, and a tool to check credit balance status.

Tips to prevent claim adjustment reason code (CARC) 54MUE

Read this article for tips on how to prevent claim adjustment reason code (CARC) 54MUE.

Ambulance modifiers

Ambulance modifiers identify the place of origin and destination of the ambulance trip and must be included on all ambulance claims.

Drugs and biologicals Part B: Using the JW and JZ modifiers

The JW and JZ modifier policy applies to all drugs separately payable under Medicare Part B described as supplied in a “single-dose” containers. Read this article to understand how these modifiers…

Ambulance modifiers

Ambulance modifiers identify the place of origin and destination of the ambulance trip and must be included on all ambulance claims.

Providers billing for drug Octagam HCPCS code J1568

Did you know the leading reason why the Recovery Audit Contractor denies the drug Octagam during a medical review is for lack of documentation? Learn more about preventing unnecessary denials.

Hospice: New requirement for physicians who certify patient eligibility

Physicians who certify patient eligibility for hospice services must enroll in Medicare or opt out effective for claims submitted on October 7, 2024 and after with dates of service June 3, 2024 or…

Hospice: New requirement for physicians who certify patient eligibility

Physicians who certify patient eligibility for hospice services must enroll in Medicare or opt out effective for claims submitted on October 7, 2024 and after with dates of service June 3, 2024 or…

Resolving claims overlapping a skilled nursing facility (SNF) stay

Is your facility receiving denials for a claim overlapping a skilled nursing facility (SNF) stay? Claims overlapping with a skilled nursing facility (SNF) stay can occur for several reasons. This…