Billing Protections for Qualified Medicare Beneficiaries

Incarcerated or Unlawfully present in the US claim rejections (U538H, U538Q)

Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q) This stringent claim editing process helps ensure that Medicare does not make payments for services rendered to beneficiaries who are not eligible due to being [...]

January 2025 EDI Front End Quarterly Release

January 2025 EDI Front End Quarterly Release Please be advised that while the Centers for Medicare & Medicaid Services mandated release for January 2025 will be installed the weekend of 1/5/2025, the code set updates included with this [...]

Screening Mammography, Pap Test and Pelvic Exam

Ensure that your patients obtain the preventive services they are eligible for by knowing the Medicare coverage, coding and billing guidelines for screening mammograms, pap tests and pelvic examinations, as well as where to find more [...]

Correct a Beneficiary's MSP Record

Table of Contents Background Step 1: Provider Receives Information Indicating Medicare Is the Primary Payer for a Beneficiary's Services Step 2: Prepare and Submit a Medicare Primary Claim With the Reason Medicare Is the Primary Payer [...]

Provisional Period of Enhanced Oversight for New Hospices

Provisional Period of Enhanced Oversight for New Hospices In recent years, CMS has reported a significant increase in fraudulent hospice billing practices, which cost the Medicare program millions of dollars annually. The CMS has initiated a [...]

Overcoming Barriers to Tobacco Counseling

Overcoming Barriers to Tobacco Counseling Healthcare providers may face different challenges when implementing tobacco cessation counseling into a clinical practice routine. These various factors influence the healthcare professionals’ [...]