Inpatient hospital entitlement changes
When a patient enrolls in or disenrolls from a Medicare Advantage plan during his/her inpatient stay, the following factors will...
PC-ACE User Guide: Section 4 – Importing claims into PC-ACE from another software
Claims are introduced into PC-ACE by either entering them manually or by importing them from an external source. The claim...
Finding fee schedule policy indicators
How to find policy indicators such as gloabl days for a service, relative value units (RVUs) for a particular code, and more.
Fee schedule par, nonpar, and limiting charge explanation
Definitions of par fee, nonpar fee, and limiting charge in the Medicare Physician Fee Schedule.
PC-ACE User Guide: Section 3 - Enter a Medicare secondary claim
The following instructions are for entering a claim with Medicare as the secondary payer. For more information on billing...
PC-ACE User Guide: Section 2 - Claim entry
More information on claim entry, including screen shots of the software, is available in the PC-ACE Institutional Training...
Checklist: Transitional Care Management services documentation
This checklist is intended to provide health care providers with a reference for use when responding to medical documentation...
Targeted probe and educate (TPE) round results: Endovascular cardiac valve replacement and supplement procedure (DRG 266 & 267)
Review the top denial/partial denial reasons and high-level results from each round of DRG 226 and 267 TPE.
Tips to prevent claim adjustment reason code (CARC) PR 96
Read this article for tips on how to prevent claim adjustment reason code (CARC) PR 96.
How do I obtain a payment information summary for lump-sum adjustments, when preparing my cost report?
A lump-sum adjustment is made depending on whether there is an underpayment or overpayment determined as a result of the interim review. These adjustments are summarized by the First Coast financial department. To accurately and timely report these lump-sum adjustments when preparing your cost report, please submit your request for detailed payment information to payinfo@novitas-solutions.com.