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Update on Processing of Medicare Claims Impacted During the Government Shutdown 

Update on Processing of Medicare Claims Impacted During the Government Shutdown 

Multiple expiring Medicare statutory payment provisions lapsed on October 1, 2025, due to the absence of Congressional action. With the...
Medicare Part B Claim Issues Impacting JK and J6 Providers 

Medicare Part B Claim Issues Impacting JK and J6 Providers 

Denied Laboratory Services and Clinical Laboratory Improvement Amendments (CLIA)   NGS Medicare has been receiving calls from providers regarding denials for...
Nov Industry Notes: Open Claims Issue for Medicare Part B 

Nov Industry Notes: Open Claims Issue for Medicare Part B 

The claims issues log below includes the status of claims processing issues that have been identified. We are actively working...
Pennsylvania Department of Human Services Prior Authorization 

Pennsylvania Department of Human Services Prior Authorization 

PURPOSE:   The purpose of this bulletin is to issue updated handbook pages that include the requirements for prior authorization and...
Nov Industry Notes: Elevance to Penalize Facilities For Out-of-network Providers 

Nov Industry Notes: Elevance to Penalize Facilities For Out-of-network Providers 

Elevance Health (Anthem) will begin penalizing healthcare facilities in 11 states starting Jan. 1, 2026, for using out-of-network providers for...
What to Know About Cigna’s and Aetna’s New Downcoding Policies 

What to Know About Cigna’s and Aetna’s New Downcoding Policies 

Cigna and Aetna are drawing provider backlash for new payment policies that reduce reimbursements. Cigna is automatically "downcoding" six Evaluation...
Benefits of Adding Primary Care Services to Your Urgent Care 

Benefits of Adding Primary Care Services to Your Urgent Care 

In the last few years, the Centers for Medicare & Medicaid Services (CMS) has accelerated its long-term effort to strengthen...
Billing Integrity in Urgent Care: How to Manage Risk 

Billing Integrity in Urgent Care: How to Manage Risk 

The financial and reputational health of an urgent care practice depends on one simple principle: bill accurately and compliantly. Yet...
Medicare Administrative Contractors Status During the Shutdown 

Medicare Administrative Contractors Status During the Shutdown 

In anticipation of possible Congressional action, CMS has instructed all Medicare Administrative Contractors (MACs) to continue to temporarily hold claims...
Update on Medicare Operations: Telehealth, Claims Processing, and Medicare Administrative Contractors Status During the Shutdown 

Update on Medicare Operations: Telehealth, Claims Processing, and Medicare Administrative Contractors Status During the Shutdown 

In the absence of a federal budget bill or continuing resolution, the government shut down on October 1, 2025, many...
September Industry Notes: Upcoming Code Change From the Medicare Bulletin:

September Industry Notes: Upcoming Code Change From the Medicare Bulletin:

For combination tests that are read visually, CPT code 87812 QW will be effective January 1, 2026. Until then, laboratories may bill CPT...
More Coding Advice from Experity RCM Team: Multiple Codes Same Body Area

More Coding Advice from Experity RCM Team: Multiple Codes Same Body Area

Something that we see frequently is multiple diagnosis codes related to the same body area being selected and billed on...
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