Oct 22, 2012 | Medical billing basics
Errors identified for business level edits performed prior to the SUBSCRIBER LOOP (2000B) will result in immediate file failure at that point. When this occurs, no further editing will be performed beyond the point of failure. The billing provider must be associated...
Oct 16, 2012 | Medical billing basics
Florida Blue recently made several changes to our claims processing system to comply with HIPAA 5010 requirements. In February 2012, process enhancements were made to ensure that a provider’s National Provider Identifier (NPI) and Tax ID number are matched...
Oct 6, 2012 | Medical billing basics
DATE(S) OF SERVICE: Dates: In the bottom, white half of the claim line, enter the begin (“From”) and end (“To”) dates of service in MM DD YY format. If a service was provided on one day only, enter the same date twice. Physician Administered Drugs: Beginning January...
Sep 27, 2012 | Medical billing basics
CHIEF COMPLAINT (CC) The CC is a concise statement describing the symptom, problem, condition, diagnosis, physician recommended return, or other factor that is the reason for the encounter. DG: The medical record should clearly reflect the chief complaint HISTORY OF...
Sep 11, 2012 | Medical billing basics
The 5010 electronic media claims (EMC) system reviews every file for a number of edits to ensure that claim data is valid. Below are the top 10 Common Edit Module (CEM) edits for 837 Part B Professional claims, in order of volume. Edit Number Business Edit...
Aug 28, 2012 | Medical billing basics
Here is an Urgent Alert to Providers in Preparation for Hurricane Isaac from United Healthcare. • If your office relocates or closes for an extended period, please contact us at 877-369-1302. • In case of a hurricane or other disaster, your patients can register on...
Aug 27, 2012 | Medical billing basics
Its information from Tricare for collection agency on their patients. Both network and non-network providers are encouraged to explore every possible means to resolve claims issues without involving debt- collection agencies. The most important action you...
Aug 24, 2012 | Medical billing basics
If the testing facility cannot reach the treating physician/practitioner to change the order or obtain a new order and documents this in the medical record, then the testing facility may furnish the additional diagnostic test if all of the following criteria apply: •...
Aug 20, 2012 | Medical billing basics
Diagnostic Test A “diagnostic test” includes all diagnostic x-ray tests, all diagnostic laboratory tests, and other diagnostic tests furnished to a beneficiary. Treating Physician A “treating physician” is a physician, as defined in §1861(r) of the Social Security Act...
Aug 15, 2012 | Medical billing basics
Audiological tests require the skills of an audiologist and shall be furnished by qualified audiologists, or, in States where it is allowed by State and local laws, by a physician or non-physician practitioner. Medicare is not authorized to pay for these services when...
