Facilities Articles and Resources

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Facility NCCI Edits Validator

Validate using NCCI edits for errors in code selection.

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Ambulatory Surgical Center Links and Resources

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Global Period/Days

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Medicare Claim Review Programs


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Part B Hospital Billing

Ch. 4 Medicare Claims Processing Manual

Billing Requirements for OPPS

Providers with Multiple Service Locations

HCUP Inpatient Payer Data

HCUP - Healthcare Cost and Utilization Project

Noridian: Quick Reference Billing Guide

Noridian: Quick Reference Billing Guide

Outpatient Facility Fees

UCR Section VA Table F Nationwide charges v3.27 (January-December 2020)

Case Mix Calculation Example

CMI – Case Mix index

Reporting of Revenue Codes Under the OPPS

Reporting of Revenue Codes Under the Outpatient Prospective Payment System (OPPS


Critical Access Hospitals

Critical Access Hospitals Fees, Designations, Etc.

Noridian: ASC Resources

Noridian JE Part B Ambulatory Surgical Center (ASC) Resources

Hospital Outpatient Regulations and Notices

Hospital Outpatient Regulations and Notices

Long-Term Care Hospital PPS

Long-Term Care Hospital Prospective Payment System

Provider Based Facilities- CMS

Owned and operated by single entities referred to as "main providers."

Ch. 5 Medicare Claims Processing Manual

Part B Outpatient Rehabilitation and CORF/OPT Services

Select the title to see a summary and a link to the full article.

Why You Should Be Using The Two-Midnight Rule


Are you using something other than two-midnight? Here’s why you shouldn’t be. Is there the possibility that your utilization management team and physician advisors are applying InterQual, MCG, or any other utilization tool other than the two-midnight rule to your Medicare admissions? Over the last few months, it has...

Using Health IT to Support Safer Use and Management of Controlled Substance Prescriptions


New ONC data show that, as of 2021, nearly all non-federal acute care hospitals were enabled to electronically prescribe controlled substances (EPCS). According to the American Hospital Association (AHA) Information Technology (IT) Supplement Survey, the proportion of non-federal acute care hospitals enabled for EPCS increased from 67% in...

The Nuances of the Two-Midnight Rule


When is a patient an inpatient? A reader we’ll call Michelle asked a question during a recent Monitor Mondays broadcast — a question that encapsulated many of them: how can a Medicare patient who stays two midnights for a non-medical reason be an inpatient?  For example, consider a...

Understanding ASCs and APCs: Indicators and Place of Service


The decision regarding the most appropriate care setting for a given surgical procedure is determined by the physician based on the patient's individual clinical needs and preferences. Of course, there is a difference in reimbursement, and the billing depends on where the procedure took place, such as an office setting, inpatient ...

PCS Coding for Ankle Fracture - Look Deeper Into the Codes!


If you're looking for ankle fractures in ICD-10-PCS, you may need to look a little deeper. Let's take a look at coding an ankle fracture such as a trimalleolar fracture. PCS coding can be confusing as it is nothing like CPT coding; with CPT we can simply code an ankle ...

UB-04 Claim Form


The UB-04 Claim Form, also known as CMS-1450, is used for submitting claims for reimbursement for specially designated facilities. The 837i is the electronic version of the form. Much like the 1500 Claim Form, maintained by the National Uniform Claim Committee, the UB-04 Claim Form is maintained by the National Uniform Billing Committee (NUBC) which maintains lists of approved codes used on various fields on the form (e.g., revenue codes, condition codes). Third-party payers, including Medicare, may have their own adaptations of the general instructions published by the NUBC.

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