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This edition includes information on the clinical lab fee schedule, chronic care management, hospice claims billed by terminated hospices, and more.
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," for instructions to add reassignments.
The claims value in dispute must meet the threshold for obtaining an administrative law judge (ALJ) hearing and a judicial review in federal district court. This is called the “amount in controversy.” The amount in controversy is recalculat…
This edition includes information for critical access hospitals, skilled nursing facilities, inpatient psychiatric facilities, and more.
Review this information for details on the 2026 enrollment application fee.
Before you request a redetermination on a denied claim, review these tips to avert delays in payment and save some valuable time.
Read the fourth quarter edition of the CERT Insider's Guide to learn more about the CERT program and the improper payment rate calculation.
Read this article for information about the CERT comparative analysis reports.
Part A and B providers can easily submit their Prior Authorization Request (PAR) forms in SPOT for certain hospital outpatient department services.
This edition includes information on the new CMS LEAD model, the new BALANCE model, 2026 updates, and more.