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CMS established the Comprehensive Error Rate Testing (CERT) program to monitor and report the accuracy of Medicare fee-for-service (FFS) payments. The CERT program measures the error rate for claims submitted to Medicare contractors. View t…
Read this article for tips on how to prevent claim adjustment reason code (CARC) PR 96.
Review the top denial/partial denial reasons and high-level results from each round of DRG 226 and 267 TPE.
This checklist is intended to provide health care providers with a reference for use when responding to additional documentation requests for transitional care management (TCM) services.
Definitions of par fee, nonpar fee, and limiting charge in the Medicare Physician Fee Schedule.
How to find policy indicators such as global days for a service, relative value units (RVUs) for a particular code, and more.
When a patient enrolls in or disenrolls from a Medicare Advantage plan during his/her inpatient stay, the following factors will determine whether to bill the Medicare Advantage plan and/or original Medicare.
There are special billing guidelines to follow when the beneficiary becomes entitled to Part A benefits in the middle of an inpatient stay.
View the qualification and documentation requirements for becoming a Medicare-enrolled clinical nurse specialist.
This edition includes information on preventing claim denials for walkers, a HCPCS public meeting, Medicare preventive services, and more.