Oct 23, 2015 | Medical billing basics
Self-Referral Services Self-referral services are defined in the HealthChoice regulations as “health care services for which under specified circumstances the MCO is required to pay without any requirement of referral or authorization by the primary care provider...
Oct 19, 2015 | Medical billing basics
Claim and encounter addresses To decrease administrative costs and improve cash flow, clinicians and facilities are encouraged to use electronic claim submission whenever possible. When it is necessary to submit paper claims, you can use the addresses below. Please...
Oct 18, 2015 | Medical billing basics
• Therapeutic procedures are procedures that attempt to reduce impairment and improve function through the application of clinical skills and/or services. • Use of these procedures requires that the practitioner have direct...
Oct 13, 2015 | Medical billing basics
MCO Excluded Services (Fee-For-Service) The MCO’s are responsible for providing all Medicaid covered services excluding the following, which are paid fee-for-service by Medicaid: Abortion Services – MCO’s are responsible for related services performed as part of a...
Oct 6, 2015 | Medical billing basics
The following clinical guidelines pertain to the specific modalities listed. G0283 – This modality includes the following types of electrical stimulation: • Transcutaneous Electrical Nerve Stimulation (TENS). • Microamperage...
Oct 1, 2015 | Medical billing basics
Payments to Managed Care Organizations Recipients are linked by their MCO to a primary care physician or clinic. All MCO-enrolled recipients are provided an identification card by their respective MCO. As a result, recipients must obtain all services except services...
Sep 24, 2015 | Medical billing basics
For claims submitted by a physician or NPP: • Services performed by non-employees or those not under a physician’s or NPP’s direct supervision are not covered. • Services not relating to a written treatment plan are not medically...
Sep 15, 2015 | Medical billing basics
Coverage Guidance Coverage Indications, Limitations, and/or Medical Necessity Notice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they are covered. When billing for non-covered services, use the...
Sep 11, 2015 | Medical billing basics
Evaluation and Management (E&M) codes are to be performed by physicians, nurse practitioners and physician assistants. Physician codes should be billed using the rendering provider’s individual NPI. 99201 Office or other outpatient visit for the evaluation and...
Sep 8, 2015 | Medical billing basics
Provider Enrollment The provider enrollment process is a critical function that assures only qualified and eligible providers are enrolled in the Medicare program. Physicians and non-physician practitioners (NPPs) who provide services to Medicare beneficiaries must...
