The Office of the Inspector General (OIG) and other federal agencies have emphasized the importance of voluntarily developed and implemented compliance plans. The OIG has supplied guidance as to the elements of a model compliance plan.
If you’re a new or seasoned provider billing dental services to fee-for-service (FFS) Medicare, or original Medicare, this article guides you through recently clarified payment provisions for dental services in 2023, the provider enrollment…
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.
The January Integrated Outpatient Code Editor (IOCE) expands editing related to manifestation diagnosis codes. Read this article to find out more about the editing.
Find information on vaccine payment allowances and fee schedules, links to related enrollment for mass immunizers, and more. Recent additions include upcoming vaccine administration coding updates beginning July 1, 2026, for TOFIDENCE® IV i…
This article provides information regarding unsolicited / voluntary refunds, that is, monies received by Medicare not related to an open account receivable.
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…