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This article provides information regarding unsolicited / voluntary refunds, that is, monies received by Medicare not related to an open account receivable.
Effective August 31, 2023, documentation is required for claims submitted with modifier 22. To avoid claim rejects and future appeals due to incorrect claim submissions, we’re providing guidance on how to properly submit a claim when applyi…
The principal physician of record appends modifier “-AI” to their initial hospital care or nursing facility visit code. All other physicians who perform an initial evaluation on this patient bill without modifier "-AI" to indicate specialty…
Providers are encouraged to use the KX modifier on 837D claims submitted with dental services inextricably linked to covered medical services. Read this article to learn more.
When a medical reviewer contacts the provider requesting to submit an attestation statement or signature log to authenticate a medical record, the provider must submit the attestation statement or signature log within 20-calendar days.
These changes were implemented April 7, 2025, effective for services January 1, 2025, and after.
This edition includes information on the 2026 institutional provider enrollment application fee, the 2026 clinical laboratory fee schedule, the 2026 MPFS final rule summary, and more.
This edition includes information on extension of Medicare provisions, HCPCS codes and clinical laboratory improvement amendment edits, hospital price transparency, and more.
Here are additional educational resources identified specifically for rural health services.
Effective July 6, 2026, outpatient claims with type of bills (TOB) 13X or 14X will be returned to provider (RTP) for reason code 34554 if modifier ER, PO, or PN is billed on all service lines, and the practice location address is missing fr…