May 3, 2012 | Medical billing basics
Effective February 27, 2012, Blue Cross and Blue Shield of Florida, Inc. (BCBSF) will implement additional changes to our Overpayment Recovery Program. These changes relax certain netting rules so our claims system can net (offset) overpaid funds quicker and more...
Apr 30, 2012 | Medical billing basics
Emergency services are defined as being services furnished to an individual who has an emergency medical condition as defined in 42 CFR 424.101. The CMS has adopted the definition of emergency medical condition in that section of the Code of Federal Regulations (CFR)....
Apr 27, 2012 | Medical billing basics
An Advance Beneficiary Notice (ABN) allows a beneficiary to make an informed consumer decision by knowing in advance that the beneficiary may have to pay out-of-pocket. An ABN is not needed where the item or service is categorically excluded from Medicare coverage or...
Apr 23, 2012 | Medical billing basics
Definition of Physician/Practitioner For purposes of this provision, the term “physician” is limited to doctors of medicine; doctors of osteopathy; doctors of dental surgery or of dental medicine; doctors of podiatric medicine; and doctors of optometry who are legally...
Apr 19, 2012 | Medical billing basics
Private Contracts Between Beneficiaries and Physicians/Practitioners Section 1802 of the Act, as amended by §4507 of the BBA of 1997, permits a physician/practitioner to opt out of Medicare and enter into private contracts with Medicare beneficiaries if specific...
Apr 15, 2012 | Medical billing basics
Care Plan Oversight Services Care plan oversight is supervision of patients under care of home health agencies or hospices that require complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of...
Apr 12, 2012 | Medical billing basics
Concurrent Care Concurrent care exists where more than one physician renders services more extensive than consultative services during a period of time. The reasonable and necessary services of each physician rendering concurrent care could be covered where each is...
Apr 9, 2012 | Medical billing basics
Physician Services General Physician services are the professional services performed by a physician or physicians for a patient including diagnosis, therapy, surgery, consultation, and care plan oversight. The physician must render the service for the service to...
Apr 2, 2012 | Medical billing basics
The supplementary medical insurance plan covers expenses incurred for the following medical and other health services under Part B of Medicare: • Physician’s services, including surgery, consultation, office and institutional calls, and services and supplies furnished...
Mar 28, 2012 | Medical billing basics
Benefit Period— The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you go to a hospital or skilled nursing facility. The benefit period ends when you haven’t received any...
