Coding Guidelines for Allergy Testing

Running an allergy practice can be exhausting and as allergy coding offers unique set of challenges. The key to establishing and maintaining an active, financially thriving allergy practice lies in a thorough understanding of the current reimbursement system and allergy coding guidelines. In this article, we shared coding guidelines for allergy testing which will help […]

Anesthesia Payment at Personally Performed Rate

In this article, we shared billing guidelines for anesthesia payment at personally performed rate and calculation of anesthesia time units. We referred Medicare billing guidelines from Medicare claims processing manual chapter 12.50 i.e., payment for anesthesiology services. You can refer payer specific billing guidelines to receive accurate anesthesia payment at personally performed rate. The A/B […]

Revised Updates for Renal Dialysis Billing

Proposed ESRD Payment System The Centers for Medicare & Medicaid Services (CMS) on June 21, 2022, issued a proposed rule that proposes to update payment rates and policies under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2023. This rule also […]

Basic Tips for Medicare Enrollment Process

Medicare enrollment is the first step towards becoming Medicare provider or supplier. CMS has shared complete process flow chart for successful Medicare enrollment. Being leading medical billing company, Medisys Data Solutions helped lots for providers and suppliers in successful Medicare enrollment. While assisting providers and suppliers, we found common mistakes made by providers or office […]

Medicare Guidelines for Laser-Assisted Cataract Surgery Billing

We are sharing Medicare guidelines for laser-assisted cataract surgery billing from a last updated CMS document. We shared this document as it was published, to avoid any error while billing for laser-assisted cataract surgery. As per CMS Ruling 05-01, Medicare will allow beneficiaries to pay additional charges (which are non-covered by Medicare as these additional […]

Reduced Co-Insurance for Screening Colonoscopies

As per the update dated 29th April 2022, CMS reduced the coinsurance for certain screening flexible sigmoidoscopies and screening colonoscopies. This special coinsurance applies regardless of the code you bill for the establishment of a diagnosis as a result of the test, or for the removal of tissue or other matter or other procedure. It’s […]

How to Prepare for a Medicare Audit

Hospital administrators, physicians, and members of every healthcare office billing department know that if their practice or hospital provides services to Medicare patients, they must be prepared to potentially receive a request for an audit. The Centers for Medicare and Medicaid Services (CMS) is responsible for devising the audit strategy and enforcing it on a […]

Wrongly Denied Claims by Private Medicare Plans

Recently published watchdog report found that private Medicare plans routinely rejected claims that should have been paid and denied services that reviewers found to be medically necessary. This report conducted by the U.S. Department of Health and Human Services inspector general investigators, which discovered that private Medicare plans denied 18 percent of claims allowed under Medicare […]

Appropriate & Inappropriate Use of Modifiers 59 & XE/XP/XS/XU

Definition of Modifier 59 The CPT Manual defines modifier 59 as Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are […]

Understanding SNF Consolidated Billing (CB)

Basics of SNF Consolidated Billing (CB) In the Balanced Budget Act of 1997, Congress mandated that payment for the majority of services provided to beneficiaries in a Medicare covered SNF stay be included in a bundled prospective payment made through the Part A Medicare Administrative Contractor (MAC) to the SNF. These bundled services had to […]