Claims
Current processing issues
A new issue was added for Part B relating to claims pending in an approved to pay location for an extended period of time.
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…
Critical access hospital (CAH) method II professional reassignments
CAH Part A Method II claims for professional services will return to provider (RTP) if a reassignment isn’t in PECOS. Watch the on-demand learning video, "CAHs Method II Professional Reassignments,"…
Method II critical access hospitals: Reprocessing certain claims with reassigned billing rights
Breaking news for critical access hospitals (CAHs): CMS has directed MACs to immediately turn off reason codes 31006 and 31007 to give providers time to submit all method II reassignments to their…