Oct 14, 2009 | Medical billing basics
Health Professional Shortage Areas In 1988 Medicare began offering incentives to physicians who render services in medically deprived areas. Health Professional Shortage Areas (HPSA s) are divided into 2 types or classifications – urban and rural. The United...
Oct 13, 2009 | Medical billing basics
Claims Processing We should know what are steps involved in insurance claims processing to better understanding. Every insurance have their own software to process the claims but the process somewhat simillar. • Does the provider have a valid contract with...
Oct 7, 2009 | Medical billing basics
Issue: Anesthesia time not on claim Action: For anesthesia claims it is mandatory to have time printed on the claim. This rule is not applicable for flat fee codes. But we have got quite few denials from the carriers who wanted anesthesia time even for flat fee codes....
Oct 7, 2009 | Medical billing basics
Issue: Pre-existing Condition Action: Pre-existing condition refers to the terms & conditions entered into between the carrier and the patient / subscriber before the beginning of the contract. The rejection will usually say that the claim is being denied due to...
Oct 4, 2009 | Medical billing basics
Health Insurance Portability and Accountability Act HIPAA in Medical billing Any healthcare provider, healthcare clearing house or health plan must comply HIPAA. Congress and the health care industry have agreed that standards for the electronic exchange of...
Sep 30, 2009 | Medical billing basics
SKILLED NURSING FACILITY•An institution or a distinct part of an institution, which has in effect a transfer agreement with one or more hospitals and is primarily, engaged in providing inpatient skilled nursing care or rehabilitation services. •Provides skilled...
Sep 27, 2009 | Medical billing basics
A Medigap policy is an individual health benefit plan offered by a private insurance company to supplement Medicare. It provides reimbursement for charges not payable because of deductible, coinsurance or other limitations. For participating providers, Medicare will...
Sep 26, 2009 | Medical billing basics
Initially, the provider is enrolled in the Medicare program as non-participating. Providers are given 90 days from the date of enrollment to choose if they want to become participating. If a provider does not choose to participate during this initial enrollment...
Sep 26, 2009 | Medical billing basics
CLAIM SUBMISSION Providers must use good faith effort to bill Insurance for services with the most current CMS approved diagnostic and procedural coding available as of the date the service was provided, or for inpatient facility claims, the date of discharge. The...
Sep 24, 2009 | Medical billing basics
Denial code co – 50 : These are non covered services because this is not deemed a “medical necessity” by the payer. Explanation and solution : It means that Medicare thinks that the submitted procedure not required to perform. Check the DX or submit...
