Finding fee schedule policy indicators
How to find policy indicators such as global 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 (TCM)
This checklist is intended to provide health care providers with a reference for use when responding to additional 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.
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.
Cost reporting requirements have been eliminated for CORFs and OPTs where 100 percent of the services are reimbursed on a fee schedule basis. Community mental health centers (CMHCs) must continue to file cost reports in accordance with the CMS website, Medicare Provider Reimbursement Manual Part 2 (PRM 15-2), Provider Cost Reporting Forms and Instructions, Chapter 1, Section 133.
If you did not furnish any covered services to Medicare beneficiaries during the entire cost reporting period, a full cost report is not required. We may authorize less than a full cost report where a provider has had low utilization of covered services by Medicare beneficiaries in a reporting period and received correspondingly low interim reimbursement payments.