Jan 7, 2015 | Medical billing basics
This page provides basic information about being certified as a Medicare and/or Medicaid home health provider and includes links to applicable laws, regulations, and compliance information. A Home Health Agency (HHA) is an agency or organization which:...
Dec 30, 2014 | Medical billing basics
Hospitals This page provides basic information about being certified as a Medicare and/or Medicaid hospital provider and includes links to applicable laws, regulations, and compliance information. A hospital is an institution primarily engaged in providing, by or...
Dec 18, 2014 | Medical billing basics
Hospice The term “hospice care” means the following items and services provided to a terminally ill individual by, or by others under arrangements made by, a hospice program under a written plan (for providing such care to such individual) established and periodically...
Dec 8, 2014 | Medical billing basics
Simply Healthcare Plans and its affiliates, Better Health and Clear Health Alliance continue to serve more than 190,000 Medicare and Medicaid members throughout Florida. Our commitment to provide value to both our members and providers is of the atmost importance....
Nov 27, 2014 | Medical billing basics
1. What if I want to change plans? If you have been approved for Medicaid, you may change your plan during the first 90 days of your enrollment. After the 90 days you will only be able to change your plan during your open enrollment period or with a...
Nov 18, 2014 | Medical billing basics
Statewide Medicaid Managed Care (SMMC) – Managed Medical Assistance (MMA) Program In 2011, the Florida Legislature created a new program called Statewide Medicaid Managed Care (SMMC). Because of this program, the Agency for Health Care Administration (AHCA) will need...
Nov 9, 2014 | Medical billing basics
CPT CODE and Description 97110 – Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility – average fee payment- $30 – $40 97113 – Therapeutic...
Oct 28, 2014 | Medical billing basics
The “payment floor” establishes a waiting period during which time the contractor may not pay, issue, mail, or otherwise finalize the initial determination on a clean claim. The “payment floor date” is the earliest day after receipt of the clean claim that payment may...
Oct 16, 2014 | Medical billing basics
Claims that do not meet the definition of “clean” claims are “other” claims. “Other” claims require investigation or development external to the carrier or FI’s Medicare operation on a prepayment basis. “Other” claims are those that are not approved by CWF for payment...
Oct 3, 2014 | Medical billing basics
The contractor must pay interest on clean, non-PIP (FIs) claims for which it does not make payment within the payment ceiling specified in § 80.2.1.1, provided payment is due on such claim. The interest rate and formula for calculation are shown above. The interest...
