Provider Enrollment: Completing the CMS-855B Paper Application

During this webinar, we'll provide an understanding of how to complete the CMS-855B provider enrollment paper application for a clinic, group or supplier.

Provider Enrollment: Completing the CMS-855A Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855A provider enrollment paper application.

Provider Enrollment: Completing the CMS-855I Paper Application

During this webinar, we’ll provide an understanding of how to complete the CMS-855I provider enrollment paper application for a group member, sole proprietor or sole owner and we’ll also focus on reassigning Medicare benefits.

Critical Access Hospitals, FQHC and RHC Quarterly Top Claim Errors

Do you struggle with your claim denials, rejections and return to provider (RTP) claims? Do you want to be proactive in preventing unnecessary errors? Join us for a review of top claim errors for your provider type based on recent data [...]

Update-CMS Delay of Skin Substitutes Effective Date

Update-CMS Delay of Skin Substitutes Effective Date As part of the transition to a new Administration, CMS is reviewing its coverage policies for skin substitute products. CMS believes it is important to maintain patient access to skin [...]

Emergency Department

Emergency Department When a consultant has seen a patient in the ED and billed an ED code, how are subsequent services billed when the patient is then admitted to inpatient status? Answer: The ED consult (billed with an ED code [...]

Behavioral/Mental Health Services

Behavioral/Mental Health Services Please explain the parameters for mental health services delivered via telehealth to a beneficiary who is at home. Answer: As of 1/1/2025, CMS has permanently extended permission for behavioral and mental [...]

Consultations

Consultations Does CMS permit payment for consultative E/M services? Answer: CMS permits payment for medically necessary consultative E/M services. The specific E/M codes previously used to represent consultative services were [...]

PC-ACE: Is there a resource I can use to assist me with Medicare Secondary Payer (MSP) claims when using PC-ACE?

DDE: Is there some place on FISS/DDE that shows how many physical therapy (PT) or occupational therapy (OT) visits the beneficiary has had?

DDE: I tried to access my claim through the FISS/DDE system and it will not let me pull it up. What is the problem?

CLAIMS: I received a denial stating that the documentation submitted did not support the medical necessity of laboratory services. Can you tell me what I can submit to support these services?

DDE: I have a claim which was fully denied and I am attempting to use the automated denial adjustment process, but the FISS/DDE system is not allowing me to adjust my claim. Why am I not able to bring up my claim and submit the adjustment?

DDE: My name changed and I need to change the name associated to my log on ID. How do I do that?

Revised and Updated Educational Frequently Asked Questions

Revised and Updated Educational Frequently Asked Questions Our educational FAQs have been updated. Please visit the Help and FAQs page under the Education section of our website to explore topics such as: ASCA Appeals CAR T-cell Therapy [...]

Teaching Environment E/M Services

Teaching Environment E/M Services Please define levels of care for E/M services that can be performed by residents in a hospital outpatient setting under the PCE rules. Answer: CMS PCE guidelines for the hospital outpatient setting permit [...]

Observation Services

Observation Services Please define guidelines for providers billing observation services. Answer: Observation services are ordered, performed and billed by the practitioner (or group), who is responsible for the patient’s care during the [...]

Split/Shared and Incident To Services

Split/Shared and Incident To Services Please define the substantive portion of a split (or shared) visit. Answer: The following factors apply in determining the substantive portion of a split (or shared) visit:   Total time [...]

Global Period Services

Global Period Services Is it permissible for providers (physicians or NPPs) other than the primary surgeon to bill for preoperative or postoperative care within a global period? Answer: The global surgery fee is paid to the primary [...]

Understanding Medicare Fraud and Abuse

Learn about fraud and abuse affecting providers and your Medicare patients to increase your awareness of integrity issues and prevent potential fraudulent and abusive practices against the Medicare Program.