On 5th Jan 2023, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), issued guidance that creates an easier path to specialty care for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries. This increased coverage of interprofessional consultations allows direct payment to consulting practitioners, expanding access […]
Increased Coverage of Interprofessional Consultations
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Covered Destinations for Ambulance Transportation
Basics of Destinations for Ambulance Transportation Ambulance transport is covered to the nearest appropriate facility to obtain necessary diagnostic and/or therapeutic services such as a CT scan or cobalt therapy as well as the return transport. In addition to all other coverage requirements, this transport situation is covered only to the extent of the payment […]
Arthroscopy Coding Guidelines
To share arthroscopy coding guidelines, we referred National Correct Coding Initiative (NCCI) policy manual. CMS developed the NCCI manual to promote national correct coding of Medicare Part B claims. The Medicare NCCI promotes correct coding methodologies and controls improper coding leading to improper payment. Before going in detail of arthroscopy coding guidelines, let’s define arthroscopy. […]
Medicare Ambulance Transports and ABNs
A physician or supplier often has a lot of doubts when it comes to ambulance transports and ABNs. Most suppliers consider ABNs a way to avoid Medicare ‘medical necessity’ denials. So let’s dive deeper into a detailed understanding of ABNs, and their appropriate use. ABNs are only rarely appropriate for ambulance services. A physician or […]
Differentiating Between Improper Payments and Medical Billing Fraud
Medical practices sometimes equate improper payments with medical billing fraud. Improper payments could be unintentional where your received payment even after not meeting program requirements. While medical billing frauds are intentional where practices might through up-coding and unbundling try to receive more insurance reimbursements than allowed. For differentiating between improper payments and medical billing fraud, let’s […]
Administration Expanding Access to Healthcare in 2024
Strengthening Affordable Care Act (ACA) Recently, the Biden-Harris Administration released the 2024 Notice of Benefit and Payment Parameters Proposed Rule that aims to further advance the Administration’s efforts to build on the Affordable Care Act’s (ACA) efforts to provide and expand access to quality healthcare options for millions of consumers. This proposed rule would increase […]
Billing by Non-Physician Providers (NPPs)
A non-physician provider (NPP) is a healthcare provider who is not a physician but who practices in collaboration with or under the supervision of a physician. NPPs may bill payers directly, rather than billing under a physician, in certain circumstances. Examples of NPPs include physician assistants (PAs); advanced practice registered nurses (APRNs); nurse practitioners (NPs); […]
General Coding Guidelines for ICD-10-CM
ICD-10-CM Basics Selecting accurate diagnosis codes using ICD-10-CM is challenging due to the availability of more than 68,000 codes. In this article, we shared general coding guidelines for ICD-10-CM which will help you in selecting accurate diagnosis codes. Before we proceed with coding guidelines, you’ll need access to two sets of lists in ICD-10 CM […]
MBC can help in Prioritizing the Patient Experience
Significance of Patient Experience There is no question that patient experience is a huge factor when it comes to the success of your practice. In case of negative patient experience, their word-of-mouth can adversely impact future patients as well as their willingness to pay bills in a timely manner. The patient experience begins as soon […]
Understanding of No Surprises Act & Good Faith Estimates for 2023 Billing
Basics of No Surprises Act The No Surprises Act went into effect on January 1, 2022. This Act is aimed at reducing ‘surprise bills’ to patients in the context of services provided at hospitals and ambulatory surgical centers and includes requirements for hospitals and ambulatory surgical centers, as well as physicians providing services at such […]