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CMS Rule Building on the CMS Interoperability and Patient Access final rule (CMS-9115-F), this proposed rule would place new requirements on Medicaid and CHIP managed care plans, state Medicaid and CHIP fee-for-service programs, and Qualified Health Plans (QHP) issuers on the Federally-facilitated Exchanges (FFEs) to improve the electronic exchange of health care data, and streamline […]
In a recent round of demands it has initiated, the HHS Office of Inspector General is targeting ambulance transportation services even as services continue to struggle financially during the pandemic. OIG is now seeking financial damages from ambulance services that may have transported patients during a Part A stay from a qualified nursing facility. Legal […]
The medical billing and coding process is a complex. When a patient presents with a significant medical history or complicated case billing can be time-consuming taking days, or months, to finalize. On top of that recent amendments to the U.S. healthcare system have added a variety of new challenges for both providers and patients. Various […]
Modifier 91 is defined by CPT® as representative of Repeat clinical diagnostic laboratory test, and is used to indicate when subsequent lab tests are performed on the same patient, on the same day in order to obtain new test data over the course of treatment. You can probably understand why it’s important to append appropriate […]
Reference (Outside) Laboratory When laboratory procedures are performed by a party other than the treating or reporting physician, the procedure may be identified by adding the modifier 90 to the usual procedure number. Modifier 90 should be appended to the procedure code representing the laboratory service that is being submitted to an outside laboratory for […]
An advance beneficiary notice is a written notice (standard government form CMS-R-131) from Medicare, given to patient before they receive certain equipment or services, notifying patient that: Medicare may not provide reimbursement for that specific procedure or treatment Patient will personally responsible for complete payment if Medicare decline payment An ABN provide an opportunity to […]
Many providers think about should I use 90834 or 90837? Both 90834 and 90837 are intended to bill for the same service – psychotherapy. The primary distinguishing factor between the two codes is time / duration of visit; 90834 is defined as 45 minutes of psychotherapy, while 90837 is defined as 60 minutes. Many therapists […]
Benefits of Chiropractic Insurance Billing When looking to increase your client base, your practice should be in-network with insurance this can help you reach new patients. Patients looking for a new provider will often turn to their coverage to find who is going to accept their insurance. You will come up as an in-network provider, […]
Modifier 53 could almost be stated to as a forgotten modifier; practices forget or just never find out how to appropriately use it. This is often partially because there’s no set definition for ‘extenuating circumstances,’ leaving it susceptible interpretation and diminishing appropriate use. It’s especially unfortunate how disused modifier 53 is, because by not using […]
Current Procedural Terminology Code 99072 Reporting: Additional supplies, materials, and preparation time required and provided by the physician or other qualified health care professional and/or clinical staff over and above those usually included in an office visit or other service(s), when performed during a nationally declared public health emergency due to respiratory transmitted infectious disease. When reporting […]