Claims

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Avoiding Hospice Claim Rejects

Determine if a patient is enrolled in hospice before billing Medicare. This article has tips on checking patient eligibility and avoiding hospice claim rejects.

Resolution Tips for Overlapping Claims

This job aid was prepared by the Part A/B and home health and hospice (HHH) MAC collaboration team to help providers that experience claim rejections for overlapping dates of service.

No Reimbursement Claims: Reason Codes 39910 and 37187

Commonly received reason codes when the Medicare deductible amount matches the full payment amount on the claim.

Private Room Billing

This article provides guidance on billing medically necessary and non-medically necessary inpatient private room accommodations.

DMEPOS HCPCS codes jurisdiction list

CMS quarterly updates the durable medical equipment prosthetics, orthotic, and supplies (DMEPOS) for DME MAC and Part B MAC jurisdictions list.

Mandatory Hospice Election Statement Addendum

The hospice election statement addendum is now mandatory for all hospice elections beginning on and after October 1, 2026.

Process for Supplying Invoice Amount on Certain HCPCS Codes - Avoid Rejected Claims

The drug codes list and the radiopharmaceutical codes list have been updated.

Encelto Cell Gene Therapy Drug

This article provides billing guidance and claim submission instructions for providers administering Encelto when provided in an ASC and HOPD settings.

Current Processing Issues

Incorrect duplicate denials have occurred for chronic care management (CCM) and remote physiological management (RPM) services billed on the same date of service as an E/M visit. Incorrectly denied…

Encelto Cell Gene Therapy Drug

This article provides billing guidance and claim submission instructions for providers administering Encelto when provided in an ASC and HOPD settings.