Jun 20, 2018 | Medical billing basics
If I receive a denial for a procedure bundled into another service, and I cannot find this code pair in the column 1/column 2 correct coding list of edits, where else should I look? Look in the mutually exclusive code list. The mutually exclusive code edits in the...
Jun 7, 2018 | Medical billing basics
WAIVER FORM NOTE: The waiver cannot be utilized for services considered to be content of another service provided. A. SITUATIONS REQUIRING A WAIVER 1. Medical necessity denials 2. Utilization denials 3. Deluxe features (Applicable to deluxe orthopedic or prosthetic...
May 5, 2018 | Medical billing basics
RETROSPECTIVE CLAIM REVIEWS The contracting provider shall have the right to a retrospective review of any claim denied in whole or in part. The purpose of a retrospective review is to allow the provider to contact customer service to determine whether the original...
Jan 11, 2018 | Medical billing basics
NURSING SERVICES Nursing services are covered on an intermittent (separated intervals of time) basis when provided by, or under the direct supervision of, a registered nurse (RN). A nursing visit may include, but is not limited to, one or more of the following nursing...
Dec 28, 2017 | Medical billing basics
GENERAL INFORMATION This chapter applies to Home Health providers. Home health is a covered Medicaid benefit for beneficiaries whose conditions do not require continuous medical/nursing and related care, but do require health services on an intermittent basis in the...
Nov 22, 2017 | Medical billing basics
VISION SCREENING PCPs must perform a subjective vision screening (i.e., by history) at each well child visit. For asymptomatic children 3 years of age and older, an objective screening must occur as indicated on the AAP periodicity schedule. For children of any age,...
Nov 7, 2017 | Medical billing basics
CHILDREN’S MULTI-DISCIPLINARY SPECIALTY (CMDS) CLINIC REQUIREMENTS CMDS clinics are required to operate under the authority of hospitals or medical universities. Hospitals and medical universities requesting CMDS clinic designation must adhere to the requirements as...
Oct 21, 2017 | Medical billing basics
E87 Other disorders of fluid, electrolyte and acid-base balance Excludes1: diabetes insipidus (E23.2) electrolyte imbalance associated with hyperemesis gravidarum (O21.1) electrolyte imbalance following ectopic or molar pregnancy (O08.5) familial periodic paralysis...
Sep 8, 2017 | Medical billing basics
CLINICAL RECORDS The following table contains general guidelines for clinical documentation that must be maintained by all providers except nursing facilities. Clinical records other than those listed may also be needed to clearly document all information pertinent to...
Jul 28, 2017 | Medical billing basics
Diseases of the blood and blood-forming organs and certain disorders involving the forming organs and certain disorders involving the forming organs and certain disorders involving the immune mechanism (D50- immune mechanism (D50-D89) Iron deficiency anemia (D50) Iron...
