Jun 20, 2018 | Medical billing basics
If I receive a denial for a procedure bundled into another service, and I cannot find this code pair in the column 1/column 2 correct coding list of edits, where else should I look? Look in the mutually exclusive code list. The mutually exclusive code edits in the...
Jun 7, 2018 | Medical billing basics
WAIVER FORM NOTE: The waiver cannot be utilized for services considered to be content of another service provided. A. SITUATIONS REQUIRING A WAIVER 1. Medical necessity denials 2. Utilization denials 3. Deluxe features (Applicable to deluxe orthopedic or prosthetic...
May 5, 2018 | Medical billing basics
RETROSPECTIVE CLAIM REVIEWS The contracting provider shall have the right to a retrospective review of any claim denied in whole or in part. The purpose of a retrospective review is to allow the provider to contact customer service to determine whether the original...
Jan 11, 2018 | Medical billing basics
NURSING SERVICES Nursing services are covered on an intermittent (separated intervals of time) basis when provided by, or under the direct supervision of, a registered nurse (RN). A nursing visit may include, but is not limited to, one or more of the following nursing...
Dec 28, 2017 | Medical billing basics
GENERAL INFORMATION This chapter applies to Home Health providers. Home health is a covered Medicaid benefit for beneficiaries whose conditions do not require continuous medical/nursing and related care, but do require health services on an intermittent basis in the...
Nov 22, 2017 | Medical billing basics
VISION SCREENING PCPs must perform a subjective vision screening (i.e., by history) at each well child visit. For asymptomatic children 3 years of age and older, an objective screening must occur as indicated on the AAP periodicity schedule. For children of any age,...
