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This edition includes information on a new model to target wasteful, inappropriate services in Original Medicare, CY 2026 proposed rules for ESRD and home health, revalidation deadline for skilled nursing facilities, and more.
Read this article to learn more about the CERT awareness month campaign focusing on responding to CERT documentation requests.
Details on submitting the credit balance report, submission deadlines, and a tool to check credit balance status.
This edition includes information on hospital price transparency, providers accepting CHAMPVA, a Medicare fraud alert, and more.
View targeted probe and educate (TPE) round results for end stage renal disease (ESRD).
View this updated listing of targeted probe and educate (TPE) review topics.
Review the top denial / partial denial reasons and high-level results of evaluation and management services – emergency department visits TPE round results.
View this information on MFA and instructions to register MFA devices.
Prior authorization is a process through which coverage is determined prior to providing or billing the service. This process allows the provider to submit documentation prior to providing or billing the service. The contractor will then al…
Surgeons append modifier 66 to claims indicating they were on a team of surgeons performing a specific procedure on the same patient during the same operative session. Billing modifier 66 requires documentation to support the claim.