May 6, 2016 | Medical billing basics
Electronic Bill Attachments (a) Required reports and/or supporting documentation to support a bill as defined in Complete Bill Section 3.0 shall be submitted in accordance with this section. Unless otherwise agreed by the parties, all attachments to support an...
Apr 30, 2016 | Medical billing basics
Procedure Modifier and Diagnosis Codes A critical element in claims filing is the submission of current and accurate codes to reflect the services provided. Correct coding is essential for correct reimbursement. Inclusion of a complete and accurate list of diagnosis...
Apr 20, 2016 | Medical billing basics
My inpatient claim is overlapping a home health episode with the same date(s) of service. How can I resolve this? A: Claims for inpatient hospital and skilled nursing facility (SNF) services have priority over claims for home health services, as beneficiaries cannot...
Apr 20, 2016 | Medical billing basics
The Centers for Medicare & Medicaid Services (CMS) will implement Change Request (CR) 9252 on January 4, 2016, effective October 1, 2015. (See related MLN Matters® article MM9252.) This CR establishes the list of covered conditions and corresponding...
Apr 17, 2016 | Medical billing basics
What does disclosing entity mean? Disclosing Entity means a Medicaid provider (other than an individual practitioner), or a fiscal agent. What does Publicly Owned mean? In the United States, a publicly owned corporation is one whose shares are traded on public stock...
Apr 10, 2016 | Medical billing basics
A: If you receive an overlap reason code, you can do one of the following: • Verify your claims submitted through direct data entry (DDE) pdf file • Option -1 (inquiry menu), then option -12 (claims summary), and key in the beneficiary’s health insurance claim (HIC)...
Apr 7, 2016 | Medical billing basics
Incomplete Antepartum Care Service CPT Billing for Incomplete Antepartum Care 59425 When billing for four to six prenatal visits 59426 When billing for seven or more prenatal visits with or without an initial visit Billing for Multiple Deliveries For additional...
Apr 1, 2016 | Medical billing basics
Q: What is an overlap? A: When an incorrect claim is processed and posted to the Common Working File (CWF), resulting in claim overlap rejection(s) of subsequent claim(s), submitted by the same or a different provider. When more than one provider is involved, the...
Mar 28, 2016 | Medical billing basics
Effective January 1, 2014, the Centers for Medicare & Medicaid Services (CMS) will require inclusion of an 8-digit clinical trial number on claims associated with clinical trial participation. Clinical trial related claims submitted to Medicare for dates of...
Mar 17, 2016 | Medical billing basics
Certified Family Home (CFH) HCPCS Description Place of Service S5140 Certified Family Home – Daily One to two participants Foster Care – Adult; per diem 1 unit = 1 day T1019 Personal Care Service per 15 minutes S5100 Adult Foster Care H2011 Crisis...
