Aug 21, 2011 | Medical billing basics
Charging members for non-covered services For Commercial members, you may seek and collect payment from our member for services not covered under the applicable benefit plan, provided you first obtain the member’s written consent. Such consent must be...
Aug 20, 2011 | Medical billing basics
NEOPLASMS [140-239] [140-149] Malignant neoplasm of lip, oral cavity, and pharynx. [150-159] Malignant neoplasm of digestive organs and peritoneum. [160-165] Malignant neoplasm of respiratory and intrathoracic organs. [170-176] Malignant neoplasm of bone,...
Aug 16, 2011 | Medical billing basics
Just like managing business accounts of any other company, medical billing comes with its own sets of rules and complexities. There are a lot of procedures to take care of and at the same time continue providing efficient, accurate and quality service. Then you also...
Aug 13, 2011 | Medical billing basics
Request for transplant or transplant-related services prior to pre-treatment or evaluation, including the following CPT Procedure Codes for Specifically Requested Transplantations: BONE MARROW – Peripheral Stem Cell 38230 Bone marrow harvesting for...
Aug 10, 2011 | Medical billing basics
[001-009] Intestinal infectious diseases. [010-018] Tuberculosis. [020-027] Zoonotic bacterial diseases. [030-041] Other bacterial diseases. [042-042] Human immunodeficiency virus (hiv) infection. [045-049] Poliomyelitis and other non-arthropod-borne viral diseases of...
Aug 10, 2011 | Medical billing basics
What Is Medicare Select? Medicare Select is a Medicare Supplement product available only to AARP® members who reside within the service area of a hospital which participates in our Medicare Select network. It is a lower cost alternative to Standardized Medicare...
Aug 8, 2011 | Medical billing basics
Our benefit plans are subject to subrogation and coordination of benefits (COB) rules. 1. Subrogation — To the extent permitted under applicable law and the applicable benefit plan, we reserve the right to recover benefits paid for a member’s health care services...
Aug 7, 2011 | Medical billing basics
Medical billing frauds are mostly related to medical insurances. In the US, such frauds may pertain to Medicare and Medicaid. Many people connected to health care sector may be involved in such frauds. The list of possible fraudsters includes beneficiaries, billing...
Aug 5, 2011 | Medical billing basics
Categories include: Transportation Services Including Ambulance A0021 – A0999 Medical and Surgical Supplies A4206 – A7509 Administrative, Miscellaneous and Investigational A9150 – A9901 Enteral and Parenteral Therapy B4034- B9999 Temporary codes for...
Aug 3, 2011 | Medical billing basics
Overpayments If you identify a claim for which you were overpaid by us, or if we inform you in writing or electronically of an overpaid claim that you do not dispute, you must send us the overpayment within thirty (30) calendar days (or as required by law),...