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Posting Date: 02/02/2021
About Appeals
About Appeals Table of Contents About Appeals Reopening vs. Redetermination Reopening Redetermination [Return to Top] About Appeals Providers and beneficiaries have the right to appeal claim determinations made by National [...]
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Posting Date: 06/30/2021
Understanding the Approval Recommendation Process for Certified Providers
Understanding the Approval Recommendation Process for Certified Providers The certified provider completes and submits a CMS-855 enrollment application and all supporting documentation to its MAC, including any state require documentation [...]
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Posting Date: 03/26/2025
REMITTANCE: What do the two-letter codes on my remittance advice mean?
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Posting Date: 03/26/2025
PC-ACE: Where can I find out more about the PC-ACE free billing software?
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Posting Date: 03/27/2025
Top JK Part B Claim Errors are Available
Top JK Part B Claim Errors are Available We conduct a comprehensive data analysis on a quarterly basis to update and disseminate the latest insights on the most common claim errors. This initiative provides: Claim Error Reason Code [...]
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Posting Date: 03/27/2025
Ensure Accurate Provider Enrollment Information on File
Ensure Accurate Provider Enrollment Information on File ATTENTION: Claims and Provider Enrollment Verify that accurate provider enrollment information is on file with Medicare. Are you familiar with the details identified in the PECOS system [...]
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Posting Date: 07/18/2023
Medical Review: Targeted Probe and Educate Review Topics
Jurisdiction K HHH Targeted Probe and Educate: Medical Review Topics Topic CPT Code(s) Common Denials Resources Home Health Medical Necessity N/A 55H3V– The documentation did not support the medical [...]
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Posting Date: 03/27/2025
Understanding the Approval Recommendation Process for Certified Providers
Understanding the Approval Recommendation Process for Certified Providers The certified provider completes and submits a CMS-855 enrollment application and all supporting documentation to its MAC, including any state require documentation [...]
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Posting Date: 03/28/2025
MLN Connects® Newsletter: March 27, 2025
MLN Connects® Newsletter: March 27, 2025 News Extension of Medicare Provisions Final National Coverage Determination: Transcatheter Tricuspid Valve Replacement Nutrition-Related Health Conditions: Recommend Medicare Preventive Services [...]
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Posting Date: 06/08/2021
Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities
Hospital Acquired Conditions and Present on Admission Resource for Acute Care Hospital Facilities The hospital is the entity required to bill POA indicators on all inpatient claims billed to Medicare. However, accurate coding of all diagnosis [...]
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Posting Date: 02/21/2025
NCCI Lookup Tool Top
National Correct Coding Initiative Lookup Tool The NCCI PTP lookup tool is designed to help providers identify when certain codes are subject to the automated code pair edits. When two codes of an edit pair are identified, the major code [...]
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Posting Date: 05/20/2024
Additional Events Links
Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders
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Posting Date: 03/15/2024
Additional Events Links
Resources Education Partnership Request Form Five Steps to Webinar Success Provider Outreach and Education Reminders
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Posting Date: 01/03/2025
Billing and Coding: Eculizumab
Billing and Coding: Eculizumab drug, hemolysis A54548 https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=54548 J1299, Q5151, Q5152
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Posting Date: 04/02/2025
Amniotic/Placental-Derived Product Injections/Applications for Musculoskeletal Indications, Non-Wound
Amniotic/Placental-Derived Product Injections/Applications for Musculoskeletal Indications, Non-Wound L39139 https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=39139 A58893 [...]
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Posting Date: 03/16/2022
Telehealth Services
Telehealth Services Table of Contents General Information Originating Site Distant Site List of Covered Medicare Telehealth Services Billing Facility Fee for Originating Site Payment for Professional Fee Place of [...]
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