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To bill correctly under the Outpatient Prospective Payment System (OPPS), please review the addendums* listed below.
Search our FAQs to find answers to common questions.
View this document to learn more about the Credit Balance Status tool.
Read this article for helpful hints for SNF claim reviews by CERT.
Read this article for tips on how to prevent claim adjustment reason code (CARC) PR 96.
There are special billing guidelines to follow when the beneficiary becomes entitled to Part A benefits in the middle of an inpatient stay.
Prior to submitting your claim, verify the revenue code(s) and/or HCPCS or CPT code combination is correct, complete, and/or valid (as applicable).
The following reason codes are frequently associated with this edit:
Read this article for tips on how to prevent reject reason code U5233.
A status R claim is a claim that was rejected for reasons such as Medicare eligibility, billing issues like overlapping with another provider’s claim, Medicare Secondary Payer (MSP) provisions, duplicate claims or claims that failed the
There are a few scenarios that exist for denial reason code CO 97, as outlined below. Please review the associated remittance advice remark code (RARC) noted on the remittance advice for your claim and then refer to the specific resources a…