Jun 28, 2016 | Medical billing basics
CPT Description 90899 Unlisted psychiatric service. This code was previously, Individual Psychiatric Therapy. Note: This is an interim code to be used by schools to be able to bill for psychotherapy services. This code should be used instead of 90804, 90806, and...
Jun 25, 2016 | Medical billing basics
F. Designation of Sex Many procedure codes have a sex designation within their narrative. These codes are not billed with codes having an opposite sex designation because this would reflect a conflict in sex classification either by the definition of the code...
Jun 23, 2016 | Medical billing basics
Correct Coding Policy The Correct Coding Initiative was developed to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The principles for the correct coding policy are: The service...
Jun 20, 2016 | Medical billing basics
Site of Service Payment Differential Under the Medicare Physician Fee schedule (MPFS), some procedures have separate rates for physicians’ services when provided in facility and nonfacility settings. The CMS furnishes both rates in the MPFSDB update. The rate,...
Jun 17, 2016 | Medical billing basics
CPT/ HCPCS Description H2011 Intervention for participant in crisis situations. (See IDAPA 16.03.10, Subsection 613.13 for specific requirements). Service is limited to a maximum of 20 hours per crisis, for 5 consecutive days. Service may not exceed 20 hours per...
Jun 15, 2016 | Medical billing basics
Certification Requirements: Who Can Perform a Face-to-Face Encounter According to 42 CFR 424.22(a)(1)(v)(A), the face-to-face encounter can be performed by: ** The certifying physician; ** The physician who cared for the patient in an acute or post-acute care facility...
Jun 13, 2016 | Medical billing basics
Certifying Patients for the Medicare Home Health Benefit This MLN Matters® SE1436 article gives Medicare-enrolled providers an overview of the Medicare home health services benefit, including patient eligibility requirements and certification/recertification...
Jun 10, 2016 | Medical billing basics
Subrogation Subrogation is another liability recovery activity in which medical costs that are the result of actions or omissions of a third party are recovered from the third party (and/or his insurer). In some instances, Tufts Health Plan has the right to recover...
Jun 8, 2016 | Medical billing basics
Modifier 26 Professional Component: Certain procedures are a combination of a physician component and a technical component. When the physician component is reported separately, the service may be identified by adding the modifier 26 to the usual procedure number....
Jun 5, 2016 | Medical billing basics
HCPCS Modifier Description Diagnosis G9002 Coordinated Care Fee, Maintenance Rate (Ongoing Children’s Service Coordination) 1 Unit = 15 minutes, PA is required. G9002 HM Service Coordination Paraprofessional, PA is required. G9003 Coordinated Care Fee, Risk Adjusted...
