The Centers for Medicare & Medicaid Services (CMS) announced in July they will be changing the way they evaluate skilled nursing facilities (SNFs), now focusing on four measures instead of one. Since ...

The Centers for Medicare & Medicaid Services issued a change request affecting the list of principal diagnosis codes that are unallowable under the Medicare hospice benefit. This change request ...

Prolia (denosumab) is a medication for osteoporosis. A healthcare professional administers Prolia via injection under the skin every 6 months. Medicare covers Prolia for beneficiaries. Since a ...

Starting July 1, dentists enrolled in Medicare will need to add an administrative modifier code to each procedure code on the ADA dental claim form, according to a Jan. 14 news release from the ...

The Centers for Medicare & Medicaid Services (CMS) issued updated guidance on the use of 340B modifiers for providers and suppliers participating in the 340B Drug Pricing Program and who bill ...

The Centers for Medicare & Medicaid Services recently shared a set of guidelines for upcoming hospice quality assurance changes. Perhaps one of the biggest new developments is that providers will soon ...

Now that the first round of price negotiations is complete, CMS' new guidelines will provide more time for drugmakers to make counteroffers, as selected drugs for round 2 will be announced by Feb. 1, ...

CMS released several proposals July 10 related to Medicare payments and claims submissions for dental services. 1. CMS is proposing to expand its list of clinical scenarios in which fee-for-service ...

The definition of the QZ modifier by Medicare is for a CRNA service without medical direction by a physician. According to the report, for Medicare, medical direction is not achieved unless the ...

Aetna will no longer provide additional payment for physical status modifier 3-5 on anesthesia claims, according to an April 19 post by medical revenue cycle management group Coronis Health. Effective ...