Jan 27, 2009 | Medical billing basics
Medicare remittance codes and its explantion M1 X-ray not taken within the past 12 months or near enough to the start of treatment. M2 Not paid separately when the patient is an inpatient. M3 Equipment is the same or similar to equipment already being used. M4 Alert:...
Jan 19, 2009 | Medical billing basics
21/Inpatient HospitalA facility, other than psychiatric, which primarily provides diagnostic, therapeutic (both surgical and nonsurgical), and rehabilitation services by, or under, the supervision of physicians to patients admitted for a variety of medical...
Jan 15, 2009 | Medical billing basics
What is POS The Health Insurance Portability and Accountability Act of 1996 (HIPAA) will become effective October 16, 2003, for all covered entities. Medicare is a covered entity under HIPAA. The final rule, “Health Insurance Reform: Standards for Electronic...
Jan 15, 2009 | Medical billing basics
What should occur when a medical provider’s bill is received by the payer?Workers’ compensation payers must respond to all medical bills. For each medical bill received for which no first report of injury has been issued, the payer must follow up by telephone with the...
Jan 14, 2009 | Medical billing basics
What information must the medical provider include on the UB 92 or CMS 1500 forms submitted to the payer?When submitting medical bills, the provider must include*:Entity’s nameEntity’s tax IDEmployee’s (patient’s) nameEmployee’s (patient’s) phone numberEmployee’s...
Jan 10, 2009 | Medical billing basics
Where is information available for medical providers treating patients with injuries/conditions that may be the subject of a workers’ compensation claim? The North Carolina Industrial Commission website. The Industrial Commission is the state agency responsible for...
Dec 21, 2008 | Medical billing basics
Medicare Remittance Group Code An ANSI Group Code is always shown with each ANSI reason code to indicate when you may or may not, bill a beneficiary for the non-paid balance of the services or equipment you furnished. Group codes are not used with Medicare Reference...
Dec 17, 2008 | Medical billing basics
Detail Fields:Serv Date: This field provides the service from and to dates as well as the patient’s responsibility.POS: The place of service field contains a two digit number that references where the services were rendered.NOS: The number of service field shows...
Nov 18, 2008 | Medical billing basics
How we can submit the secondary claims by electronic Insurance primary to Medicare should be reported in Items 4, 6, 7, 10 (a-c) and 11 (a-c). For electronic claims only, it is imperative the correct two-digit Medicare Secondary Payer (MSP) insurance type code is...
Nov 17, 2008 | Medical billing basics
Claim StatusWait for the 14 day electronic and 29 day paper payment floor before calling-use the IVR systemRemittance AdviceGroup Code meanings to assist providers in reading remittance advices Payment CalculationMedicare payment at 80% of the allowable, minus...
