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Posting Date: 11/29/2021
Remittance Advice
Remittance Advice Table of Contents General Information Electronic Remittance Advice Remittance Message Codes Standard Paper Remittance General Information Once Medicare has processed a claim, the provider will receive a notice [...]
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Posting Date: 10/14/2021
Requesting an Exception to Timely Filing
Requesting an Exception to Timely Filing Table of Contents Requesting an Exception to Timely Filing No Appeal Rights for Claims Denied Based on Timely Filing Limit Provider Liability Exceptions that May Allow the Time Limit to be [...]
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Posting Date: 10/19/2022
Outpatient Services for Registered Inpatients
Outpatient Services for Registered Inpatients There are occasional circumstances in which a registered inpatient may require a service that is not available at the inpatient facility. These inpatient facilities include acute-care hospitals [...]
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Posting Date: 10/19/2022
Allergen Immunotherapy Preparation (95144-95165)
Allergen Immunotherapy Preparation (95144‑95165) National Government Services will allow the preparation and provision of antigen for allergen immunotherapy, codes 95144 through 95165 when performed incident to by auxiliary personnel. However, [...]
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Posting Date: 10/19/2022
CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy
CPT Code 15830: Excision, Excess Skin and Subcutaneous Tissue; Abdomen, Infraumbilical Panniculectomy CMS created the Medicare Physician Fee Schedule Look-up Tool for MACs to follow when processing claims. CMS listed CPT code 15830 as a [...]
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Posting Date: 10/19/2022
Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid
Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid Table of Contents Fee-For-Time Compensation Arrangement and Reciprocal Billing Job Aid Fee-For-Time Compensation Arrangements Reciprocal Billing Arrangements Related [...]
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Posting Date: 10/19/2022
Answers to Common Fee-for-Time Compensation Arrangements Questions
Answers to Common Fee-for-Time Compensation Arrangements Questions Does a fee-for-time compensation arrangement physician need to enroll with Medicare prior to acting as a physician? Answer: Currently, a fee-for-time compensation [...]
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Posting Date: 10/19/2022
Nonphysician Practitioners Billing for Surgical Procedures
Nonphysician Practitioners Billing for Surgical Procedures Several providers have asked about the Medicare guidance for NPPs include billing for surgical procedures. For the purpose of this education, NPPs include NPs, PA, and CNSs. State law [...]
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Posting Date: 10/20/2022
Professional Services During a Patient Hospice Election
Professional Services During a Patient Hospice Election Table of Contents Article Overview Hospice Election Medicare Payment During Hospice Election Determining the Correct Entity to Bill Separately Payable Part B Services Hospice and [...]
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Posting Date: 10/19/2022
Proper Billing for Finger and Toe Procedures
Proper Billing for Finger and Toe Procedures When billing for procedures that are performed on the fingers and/or toes, it’s essential to append the appropriate anatomical modifier for the service rendered. This allows the patient history to [...]
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Posting Date: 10/19/2022
Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements
Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements Table of Contents Proper Submission of Fee-For-Time Compensation Arrangements and Reciprocal Billing Arrangements Fee-For-Time Compensation [...]
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Posting Date: 09/08/2021
Proper Use of Taxonomy Codes
Proper Use of Taxonomy Codes A taxonomy code is a unique ten-character code that designates your classification and specialization and enables providers to identify their specialty at the claim level. CMS developed a crosswalk of [...]
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Posting Date: 10/19/2022
Common Reciprocal Billing Questions and Answers
Common Reciprocal Billing Questions and Answers If a practice, the same specialty as ours, wants us to take calls for them for two weeks, can we bill under their number as a reciprocal billing arrangement? Answer: No. In a reciprocal [...]
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Posting Date: 10/19/2022
Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans
Reminder for Avoiding Claim Denials for Positron Emission Tomography Scans Background It has been noted that a high volume of PET scan claims falling between the CPT code range 78811–78816 are being denied upon original claim submission due [...]
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Posting Date: 10/19/2022
Unlisted and Not Otherwise Classified Procedure Codes
Unlisted and Not Otherwise Classified Procedure Codes Table of Contents Unlisted and Not Otherwise Classified Procedure Codes Proper Billing for NOC Procedures Electronic Claims Paper Claims The following tips will help you bill [...]
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Posting Date: 03/17/2023
Fiscal Year/Calendar Year Claim Split
Fiscal Year/Calendar Year Claim Split Part A/B Type of Bill Fiscal Year Split Calendar Year Splint Part A – 11X, 21X prospective payment system (PPS*) No No Part A – 11X, 18X, 21X, non-PPS Yes [...]
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Posting Date: 12/16/2020
The Medicare Home Infusion Therapy Benefit and Home Health Agencies
The Medicare Home Infusion Therapy Benefit and Home Health Agencies If you are a HHA that wants to provide and bill Medicare HIT professional services starting in CY 2021, you are required to enroll with the Part B Medicare Administrative [...]
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Posting Date: 09/13/2022
Medicare Coverage for Living Organ Transplant Donors
Medicare Coverage for Living Organ Transplant Donors Table of Contents Coverage Hospital Guidelines Physician Guidelines Billing Guidelines Transplant Centers Physicians and Surgeons Related Content [Return to Top] Coverage [...]
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Posting Date: 11/26/2018
Kidney Transplant Services
Kidney Transplant Services Table of Contents Kidney Transplant Services Physician Services Pretransplant Services Immunosuppressive Drugs Cadaver Donor Updated CMS-1500 Claim Form Guidelines [Return to Top] Kidney Transplant [...]
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Posting Date: 09/03/2024
September 2024
In This Issue National Government Services Articles for Part A and Part B Providers Introducing the All-New Medicare University! Removal of Facet HCPCS Codes National Government Services Articles for Part A Providers [...]
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