CMS Medicare Require Global Surgery Reporting for Post-Op Visits for 9 States
Aug16

CMS Medicare Require Global Surgery Reporting for Post-Op Visits for 9 States

CMS Require Global Surgery Reporting for Post-Op Visits Effective July 01, 2017 from 9 States  CMS now require providers who are part of a group practice with 10 or more providers; and are practicing in the State of Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island to report CPT Code 99024 to indicate a… Please LOGIN HERE to view this content. Or, REGISTER HERE Find this article useful? Please comment below and share what you just found from this website! Go ahead - please click "SHARE"EmailTweetShare on...

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Physician Provider Going Out of Network with the Insurance Company | Think Again
Aug05

Physician Provider Going Out of Network with the Insurance Company | Think Again

Going Out of Network with the Insurance Company, think again (especially when you are a Primary Care Provider)   How long ago have you revisited your contracts? when was the last time you have reviewed your contracts? – maybe 3, 5 or even 10+ years ago?). Three biggest reasons why provider would pursue going out of network: 1. If you are no longer happy with your payers’ contracted rates or because the contracted rates keep on changing; 2. Timely filing limit policy is also one reason; 3. Reimbursement Policy Guidelines (bundling services into one payment); But Before you go out of network, here are the things you might consider and take a look at: 1. As you know, not all your patients have an out-of-network benefits. You have to understand that because of this, your existing patients must be transferred to another provider or facility that accepts in-network benefits. Otherwise, out of network deductible/coinsurance will apply towards your patients’ responsibility; 2. Your patients population will likely decrease due to patients’ being without an out-of-network benefits. 3. Some insurance company would send the payment check for your rendered services made payable to their member or your patient because you are an out-of-network provider (isn’t this so true?); 4. When you are following-up on claim status, some insurance company will not disclose a more detailed information regarding the claim status (especially denial and rejection) not unless the patient (their member) will call them; (reality! – hold time for out-of-network provider on the phone is probably 20 minutes minimum!) – isn’t this true? Who had experienced this? (please share your thoughts below on the comment box); I do think the best action to do it — before terminating your contract with the insurance company is to try to NEGOTIATE first. Our company can help you with the process in negotiating with the insurance payer. Contact us here. Talk to your provider relations manager in the area. Discuss your intention of going out of network and ending your contract. Tell them your reasons why you want to terminate the contract. I know the insurance company will be willing to negotiate your contracted rate or your entire contract as a whole! Especially if they know it will affect their “members” — your patients! Now, if in the end, you still have decided to terminate the contract. Just make sure you inform your patients ahead of time and bluntly explain to them your reasons why you are terminating the contract with their insurance company. Explain it to the patients what and how this will affect them. The financial responsibility they might incur for being out...

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Can a Doctor Waive a Patient Copay | Medical Practice Offices Need to Know
Jul31

Can a Doctor Waive a Patient Copay | Medical Practice Offices Need to Know

If you are participating and contracted with the insurance payers, you cannot legally waive a copayment because your contract (which is a legal document/agreement) is clearly stating and you agree that you need to collect the copay at the time of service or something like that. See, you have a contracted rate with the insurance right? And so this is how it works: Can a Doctor Waive a Patient Copay, Medical Practice Offices Need to Know For Example: If for that visit, CPT  Code 99213, your contracted rate with insurance payer is $77.89 and on that particular claim: They allow $77.89; Paid you $62.89 Applied $15.00 towards the patient’s copay ==> $62.89 (insurance payment) + $15.00 (Copayment of the patient) = YOUR AGREED CONTRACTED AMOUNT OF $77.89 Now, if you did not collect the copay for a processed claim (see above scenario); the contracted/allowed should have been $62.89 and NOT $77.89 – make sense? And besides that. if you don’t collect the copay, you are losing money!   This is the reason you cannot waive the copayment because it is part of your agreed and contracted rate with the insurance payer. I have always advised my clients to collect the Copayment at the time of service, this will also help your daily cash flow. Strategies on How to Effectively Collect Copayments: When they call for appointment, as a courtesy let them know what their benefits are including their copayments; When you call the patient to confirm an appointment, remind them that they have a copay for tomorrow’s visit; Accept  Credit Cards and Debits Cards (avoid personal checks if possible); If they forgot their purse and don’t have their check, offer credit card payment method or direct them to a nearest ATM Machine in the area For stubborn patients, just nicely tell them you are contracted with their insurance company and your contract says you have to collect copays at the time of service; Advise the patient to call their insurance if they still have issue with you collecting their copayment at the time of service   Searched Keywords: waiving copays and deductibles waiving medicare co-payments pharmacy waive copay is it illegal to write off health insurance copays copay collection policy copay waiver form waive copay meaning oig advisory opinion waiver of copay GOT QUESTION FOR ME?   Need Immediate Help?  CHAT WITH US/TEXT/CALL  (888) 822-0862 We have been helping our Physicians Achieve a more Profitable Medical Practice through our Revenue Cycle Management Solutions, Practice Management and Business Development Strategies. We are your Partner for Success. If you are Struggling with your: 1. Revenue Cycle Management 2. Cash Flow 3. Claims...

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List of Medical Modifiers for Durable Medical Equipment DME Billing Services | Modifiers
Jul28

List of Medical Modifiers for Durable Medical Equipment DME Billing Services | Modifiers

searched terms: List of Medical Modifiers for Durable Medical Equipment DME Billing Services Keypoints: Make sure you have identified medical necessity for a DME Durable Equipment Item Make sure you have documented the necessity Make sure you have a delivery receipt that the patient had received the DME Item Make sure you are reporting the right DME Item Make sure you are reporting the right place of service Make sure you have checked with your payer how they want you to report the DME Item on your Claims SEE Example of HCFA 1500 Claim Form on How to Use DME Durable Medical Equipment Modifiers CLICK HERE!   List of Medical Modifiers for Durable Medical Equipment DME Billing Services RR — RENTAL. (USE THIS ‘R’ MODIFIER WHEN DME IS TO BE RENTED) This modifier is used for DME items that are rented, and will be used for equipment in the following categories: Inexpensive or other Routinely purchased DME (IRP), Frequent or Substantial Servicing (FS), Certain customized items, Other Prosthetic and Orthotic Devices (P & O), Capped Rental Items (CR), Oxygen and Oxygen Equipment. KH — DMEPOS ITEM, INITIAL CLAIM, PURCHASE OR FIRST MONTH RENTAL This modifier is used for a capped rental DME item. When using the KH modifier, you are indicating you are billing for the first month of the capped rental period. KJ — DMEPOS ITEM, PARENTERAL ENTERAL NUTRITION (PEN) PUMP OR CAPPED RENTAL, Month four to fifteen This modifier is used for capped rental DME items. When using the KJ modifier, you are indicating you are billing for months four through thirteen/fifteen of the capped rental period. KI — DMEPOS ITEM, SECOND OR THIRD MONTH RENTAL This modifier is used for capped rental DME items. When using the KI modifier, you are indicating you are billing for the second and/or third month of the capped rental period. searched terms: List of Medical Modifiers for Durable Medical Equipment DME Billing Services   A8 — DRESSING FOR EIGHT WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A5 — DRESSING FOR FIVE WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A4 — DRESSING FOR FOUR WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes billed without modifiers A1-A9 (see Coding Guidelines) are noncovered under the Surgical Dressings benefit. Certain dressings may be covered under other benefits. A9 — DRESSING FOR NINE OR MORE WOUNDS. (EFFECTIVE DATE 1/1/2003) Surgical dressing codes...

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DME Durable Medical Equipment Billing Coding Modifier RR, KH, KJ, KI – Rental DME Modifier
Jul27

DME Durable Medical Equipment Billing Coding Modifier RR, KH, KJ, KI – Rental DME Modifier

These modifiers are used for DME Durable Medical Equipment Services Billing: RR – DME Item – RENTAL  Secondary Modifiers: KH, KI, KJ KH — DME Item, FIRST MONTH RENTAL. KI — DME Item, SECOND OR THIRD MONTH RENTAL KJ — DME Item, RENTAL, MONTHS FOUR TO FIFTEEN Always check with your payers, every payer has a different way of billing the DME using these modifiers. Kindly see below DME billing HCFA 1500 images:   Range of Date of Service (From-To): DME Durable Medical Equipment Billing Coding Modifier RR, KH, KJ, KI – Rental DME Modifier   One (Same) Date of Service (From-To): DME Durable Medical Equipment Billing Coding Modifier RR, KH, KJ, KI – Rental DME Modifier     RELATED DME DURABLE MEDICAL EQUIPMENT BILLING (CLICK THE LINKS BELOW)   List of Medical Modifiers for Durable Medical Equipment DME Billing Services | Modifiers DME Modifiers use for DME Durable Equipment Billing | How to Bill for DME Medical Billing DME | DMEPOS EXEMPTIONS for Accreditation and Surety | For Physicians, Non-Physicians, Physical Therapist and Occupational Therapists DME Durable Medical Equipment Billing Coding Modifier RR, KH, KJ, KI – Rental DME Modifier How to Bill for DME L3908 for Medicare of NC   Searched Keywords: DME Durable Medical Equipment Billing Coding Modifier RR, KH, KJ, KI – Rental DME Modifier modifier kh dme modifiers list dme modifier kx dme modifiers 2016 medicare dme modifiers 2016 dme modifiers 2017 modifier bp modifier ms   Need Immediate Help?  CHAT WITH US/TEXT/CALL  (888) 822-0862  We Offer CONSULTING SERVICES and REVENUE CYCLE MANAGEMENT We always OVER-DELIVER! 100% Satisfaction Guaranteed. Or we will return your money!   Medical Practice Consulting, Business Development and Revenue Cycle Management EXPERTISE are in: 1. Pain Management Medical Billing Consultant 2. Orthopedic Medical Billing Consultant 3. General Surgery Medical Billing 4. Obesity Medicine Billing 5. Documentation Review and Claims Audit * Accurate Coding * Evaluation and Management Coding * Medical Necessity * Compliance Plans * CPT Coding Level * CCI Edits Conflicts * Payor Guidelines and Policies (Clinical, Utilization and Reimbursement) * ICD-9, ICD-10, HCPCS Codes * Medicare and Medicaid Guidelines and Policies 6. Anesthesiology Billing 7. Neurology Billing 8. Physical Therapy Billing 9. Physician Insurance Credentialing 10. DME Durable Equipment Billing 11. Workers Comp Billing 12. MVA Claims Billing 13. Chiropractor Practice Medical Billing Medical Billing, Coding, Reimbursement and E/M Questions? We can help you navigate your practice on how to INCREASE REVENUE by looking at additional Services that you can possibly do in your Practice based on your Specialty. Other Services We Offer: Setting up a Medical Practice Revenue Cycle/Reimbursement Management Insurance Credentialing and Contract NegotiationsMedicare Enrollment and Credentialing Chart Auditing Staff Training Compliance Program TESTIMONIALS and...

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