Apr 25, 2017 | Medical billing basics
Q: My patient enrolled in a Medicare Advantage (MA) plan during the middle of the inpatient hospital stay. Who should I bill? A: When a patient enrolls or disenrolls in a MA plan during his/her inpatient stay, the following factors will determine whether to bill the...
Nov 11, 2015 | Medical billing basics
BILLING INFORMATION Providers must bill on the CMS-1500. Claims can be submitted in any quantity and at any time within the filing limitation. Filing Statutes: Claims must be received within 12 months of the date of service. The following statutes are in addition to...
Oct 23, 2015 | Medical billing basics
Self-Referral Services Self-referral services are defined in the HealthChoice regulations as “health care services for which under specified circumstances the MCO is required to pay without any requirement of referral or authorization by the primary care provider...
Oct 13, 2015 | Medical billing basics
MCO Excluded Services (Fee-For-Service) The MCO’s are responsible for providing all Medicaid covered services excluding the following, which are paid fee-for-service by Medicaid: Abortion Services – MCO’s are responsible for related services performed as part of a...
Oct 1, 2015 | Medical billing basics
Payments to Managed Care Organizations Recipients are linked by their MCO to a primary care physician or clinic. All MCO-enrolled recipients are provided an identification card by their respective MCO. As a result, recipients must obtain all services except services...
