Nov 14, 2016 | Medical billing basics
Timeframe for Claims Submission Providers must submit clean claims within 90 days of the date of services or the date of discharge for inpatient services. The 1199SEIU Benefit Funds may deny claims submitted more than one year after the date of service or discharge...
Nov 9, 2016 | Medical billing basics
Primary care practitioners are defined as: (1) A physician who has a primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatric medicine for whom primary care services accounted for at least 60 percent of the allowed charges...
Nov 6, 2016 | Medical billing basics
Bundling of Payments for Services Provided in Wholly Owned and Wholly Operated Entities (including Physician Practices and Clinics): 3-Day Payment Window In accordance with section 102(a)(1) of the PACMBPRA, for outpatient services furnished on or after June 25,...
Nov 2, 2016 | Medical billing basics
Effective: 01-01-11 and 04-04-11, Implementation: 01-03-11 for the claim identification of the incentive and 04-04-11 for full implementation) The incentive payment applies to major surgical procedures, that are defined as 10 – and 90 – day global...
Oct 31, 2016 | Medical billing basics
HYPERTENSION Definition Change In ICD-10, hypertension is defined as essential (primary). The concept of “benign or malignant” as it relates to hypertension no longer exists. When documenting hypertension, include the following: 1. Type e.g. essential, secondary, etc....
Oct 28, 2016 | Medical billing basics
For services with dates of service prior to January 1, 2005, physicians must indicate that their services were provided in an incentive-eligible rural or urban HPSA by using one of the following modifiers: QB – physician providing a service in a rural HPSA; or...
Oct 24, 2016 | Medical billing basics
HPSA designations are made by the Health Resources and Services Administration’s (HRSA) Division of Shortage Designation (DSD). An automated file of areas eligible for the HPSA bonus payment will be updated on an annual basis and will be effective for services...
Oct 21, 2016 | Medical billing basics
procedure code and description 36561- Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older – average fee payment – $1250 – $1350 INSERTION OF CENTRAL VENOUS CATHETER 360.00...
Oct 20, 2016 | Medical billing basics
A. Payment for Professional Component (PC) Services Payment may be made under the physician fee schedule for the professional component of physician laboratory or physician pathology services furnished to hospital inpatients or outpatients by hospital physicians or by...
Oct 20, 2016 | Medical billing basics
procedure code and description 27130- Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft – average fee payment – $1510 -$1520 27445 Arthroplasty, knee, hinge prosthesis...
