Understanding Billing for Allogeneic Stem Cell Transplants and Acquisition Charges


 The charges associated with the allogeneic stem cell transplant, codes 0819, are still a mystery for many billers. Objectives: This article addresses the charges associated with this special billing and provides information regarding the reason for payment and comparison with autologous transplants, through an interpretative process of the Medicare Publication. Conclusions: Deciphering these intrigues is a complex matter that will help healthcare provider to bill and improve reimbursement.

Billing for Allogeneic Stem Cell Transplants - Revenue code 0819

This article addresses the principles and details surrounding the acquisition charges for allogeneic stem cell transplants, including types of services included in acquisition charges and the charges themselves. Payment mechanisms are explained in the hospital outpatient and inpatient settings, along with acquisition charges as part of a prospective payment system. There is a discussion about costs and billing for allogeneic and autologous transplants. This article helps the reader understand the unique aspects of acquiring the right donor and processing allogeneic and not autologous stem cells. read more 

Must required Date elements EMC 837

Understanding the Essential Data Elements in Medicare Claims: EMC 837 Guidelines

 process includes complying with up to 1,000 EMC 837 data-element requirements Most of these elements supplement—but are not the same as—the detailed Health Insurance Portability and Accountability Act (HIPAA) requirements. In general, carriers must process your paper claims if they adhere to these requirements, which are similar in scope and volume as the EMC 837 ones. For example, ICD-10-CM/PCS.) Often, you will have to submit these same NPIs on your paper claims. In summary, plan to find and correctly enter up to 1,000 EMC 837 data-element requirements into your electronic claims processing software and/or your employees’ brains. When you do, your claim will process rather than be rejected with a non-standard processing code or returned with the missing documentation note in the remittance advice. For emphasis and inaccurate claims under Payments to Providers, many carriers must return invalid claims to you when they’re missing the following elements: the predetermined valid Medicare Health Insurance Claim Number (HICN) or patient data. Note that the same requirements apply to your other Medicare work! read more.

Effective date of provider termination

Understanding Effective Dates for Provider Termination in Medicare

 This informative article details the nuisances and concerns around provider termination dates within the Medicare program. It details the process of termination, employment of quality health care while administratively streamlining the process, the delegation of authority by Medicare to its Fiscal Intermediaries (FIs) and Regional Offices (ROs) on such terminations and along with it, the role of the FIs and ROs in filing the requisite documents and the provision of necessary notifications to CMS.Subsequently, the article details the payment authorities to be exercised by the FIs and ROs, terms and conditions that would be supplied to the Providers for following while terminating, required actions to be followed by the Providers within the concluded period of their valid dates, the criteria established by Medicare to approve the various proposed termination dates and the consequences alongside process of invalidation of such terminations.Finally, the article concludes with the role of the FIs and ROs in making due notifications to the Medicare beneficiaries and information to the American public through newspaper notices. Additionally, the Administrative Law Judge, in meting out fines, is further empowered to revoke the Medicare Billing Number.In addition to these, the medicare authorities at CMS has reserved the right to strengthen or enhance, the regulations of these termination dates on need basis. read more.

Meaning of Accept Assignment?

This is a fascinating and thorough look into the concept of accepting assignment under Medicare Part B, and an extremely clear explanation of what it means when you ‘accept assignment’. In summary, you are asking that Medicare pay you directly for covered services, with certain restrictions on the amounts that you can charge your beneficiary. The article defines the scope and effective date of your agreement to accept assignment under Medicare Part B, and how that agreement should be automatically renewed year after year, unless you choose to terminate it. This will be incredibly useful for all healthcare providers who bill through Medicare, as well as for all Medicare beneficiaries. read more.

Present On Admission (POA) Indicators

Present On Admission (POA) indicators are a necessary and much-discussed part of nearly all admissions for Medicare billing. This paper reviews Medicare’s guidelines for reporting POA indicators in order to guide hospitals in reporting for the inpatient-prospective payment system. Reporting and use of diagnoses and procedures by the guidance and necessities of Medicare are covered extensively in this document to ensure the importance of reporting of accurate diagnoses and appropriate procedure coding as it relates to the POA indicator: before, at, or after the decision to admit to an inpatient bed. Present on Admission reporting guidance is covered abundantly for both indirect and direct POA reports, and each definition is explained in detail. read more.


In conclusion, to process Medicare claim billing, providers must have full information about data elements, termination, assignment acceptance, and reporting (see below). Providers must submit data up to 1,000 elements when using EMC 837. All these elements should be completed properly, without mistakes, and this submission should guarantee no claims rejection or delay due to missing or incorrect data. In addition to EMC 837 submission, providers should always inform themselves about effective dates of Medicare provider termination (see below details, as mandated by Medicare regulations) and all responsibilities of Fiscal Intermediaries and Regional Offices, who have to make decisions on termination and who are to notify all the beneficiaries about new prescriptions. Full understanding by healthcare providers and beneficiaries of the meaning of “accepting assignment” under Medicare Part B is essential to secure direct payment of covered services when claim is submitted (see below), but also to understand what are the limitations of payment. Finally, proper reporting for Present On Admission (POA) indicators when billing Medicare is of utmost importance, which is because POA is a mandatory reporting for diagnosis and procedure code when patient needs to stay in inpatient care. Through this submission, all errors are excluded. In conclusion, adherence for all these questions makes Medicare billing work properly, facilitates patient care, and also complies with Medicare regulations.