Aug 11, 2012 | Medical billing basics
Occupational Therapy Evaluation (CPT code 97003) and Occupational Therapy Re-evaluation (CPT code 97004) Evaluation is a comprehensive service that requires professional skills to make clinical judgments about conditions for which services are indicated based on...
Aug 7, 2012 | Medical billing basics
Claim Check The TRICARE West Region contract uses a version of the McKesson HBOC ClaimCheck® product to review non-Outpatient Prospective Payment System (non-OPPS) claims on a prepayment basis for unbundling. ClaimCheck is an automated product that...
Aug 2, 2012 | Medical billing basics
Global Maternity Claims Global maternity involves the billing process for maternity-related claims for a beneficiary. Once a beneficiary has been diagnosed as pregnant, all charges related to the pregnancy are grouped under one global maternity...
Jul 30, 2012 | Medical billing basics
Lab and Radiology Billing When submitting claims for laboratory or radiology services rendered in a hospital setting, inpatient or outpatient, and you are a professional provider, use modifier 26 to indicate that you are billing for the professional...
Jul 26, 2012 | Medical billing basics
Beneficiary Signature Requirements Medicare requires the signature of the beneficiary, or that of his or her representative, for each date of transport, for both the purpose of accepting assignment and submitting a claim to Medicare. If the beneficiary is unable to...
Jul 20, 2012 | Medical billing basics
Billing with Unlisted Procedures Some procedures may not be found in any level of Healthcare Common Procedure Coding System (HCPCS). Typically, these are services that are rarely provided, or are unusual, variable, or unlisted procedures. In order...
Jul 17, 2012 | Medical billing basics
Electronic Remittance Advice The electronic remittance advice (ERA) can help improve the workflow and productivity of your business office. Available through WPS, the ERA can be automatically loaded into your accounts receivable system, depending upon your...
Jul 12, 2012 | Medical billing basics
Proper Appealing Parties • The TRICARE beneficiary (including minors) • The non-network participating (accepts assignment) provider of services • A non-network participating (accepts...
Jul 8, 2012 | Medical billing basics
MEDICARE PHYSICIAN FEE SCHEDULE Medicare Part B pays for physician services based on the MPFS, which lists the more than 7,000 covered services and their payment rates. Physician services include the following: Office visits; Surgical procedures; and A range of other...
Jun 21, 2012 | Medical billing basics
The following guidelines will help expedite your referral and authorization requests: • Submit an online request or, if that option is not available to you, use the TRICARE Patient Referral/Authorization Form for any TRICARE Prime beneficiary...
