New Fiscal Intermediary Shared System (FISS) consistency edit to validate attending physician NPI
Effective April 1, CMS implemented a new consistency edit to validate the attending physician NPI. Claims are returning with...
Resolve claim return reason code 34963 for outpatient therapy services
Are you providing outpatient therapy services on institutional claims and receiving reason code 34963 indicating the attending...
Medicare requirements on documenting E/M services by teaching physicians
CMS has new guidelines for teaching physicians effective January 1, 2022. These updates were implemented February 15, and...
Responding to additional documentation requests (ADRs)
This article explains how to respond to ADRs.
Process for pathology, laboratory, and other codes
Avoid negative impacts to your claims by providing the medical records for the laboratory and pathology code claim submissions...
Critical care services
CMS has new guidelines for critical care services effective January 1, 2022. These updates were implemented February 15, and...
Payment of codes for chemotherapy administration and nonchemotherapy injections and infusion
CMS provided clarification regarding the Medicare guidance relating to complex administration CPT codes 96401-96549. Please read...
Process for CPT category III T codes
Review the revised listing of CPT category III T codes that require documentation to avoid negative impacts to your claims.
Prohibition on billing dually eligible individuals enrolled in the Qualified Medicare Beneficiary (QMB) program
This article provides guidance to avoid inappropriately billing Qualified Medicare Beneficiaries (QMBs) for Medicare cost...
National Correct Coding Initiative (NCCI)
The National Correct Coding Initiative (NCCI) was developed to promote national correct coding methodologies and to control...