Prohibition on billing dually eligible individuals enrolled in the Qualified Medicare Beneficiary (QMB) program
This article provides guidance to avoid inappropriately billing Qualified Medicare Beneficiaries (QMBs) for Medicare cost...
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Kisunla for monoclonal antibodies directed against amyloid for the treatment of Alzheimer's disease
Effective July 2, Medicare will pay for Kisunla for monoclonal antibodies directed against amyloid for the treatment of...
Payment of codes for chemotherapy administration and nonchemotherapy injections and infusion
CMS provided clarification regarding the Medicare guidance relating to complex administration CPT codes 96401-96549. Please read...
Intensive outpatient program (IOP) billing requirements for institutional services
Effective January 1, 2024, IOP services are available for both individuals with mental health conditions and individuals with...
Reciprocal billing and fee-for-time compensation arrangements (formerly locum tenens arrangements)
The requirements for the submission of claims under reciprocal billing and fee-for-time compensation arrangements are the same...
Leqembi for monoclonal antibodies directed against amyloid for the treatment of Alzheimer's disease
Providers may be billing these services incorrectly. Please review this article and pay close attention to the billing loop and...
Multiple procedure payment reduction on the professional component and technical component of certain diagnostic imaging procedures
The MPPR on diagnostic imaging applies when multiple services are furnished by the same physician to the same patient in the...
Multiple procedure payment reduction
Medicare applies a MPPR to the payment of select therapy services. The reduction applies to HCPCS codes contained on the list of...
New Fiscal Intermediary Shared System (FISS) consistency edit to validate attending physician NPI
Effective April 1, CMS implemented a new consistency edit to validate the attending physician NPI. Claims are returning with...
RTP reason code 34963 FAQ
Read this article to learn how to resolve claim rejects for reason code 34963.