Medicare Enrollment Application Information: MBC

CMS received approval for a new Medicare Enrollment Application for physicians and non-physician practitioners (CMS-855I dated 12/2018). Many changes are minor; the major ones reduce provider burden: Eliminated reporting for advanced diagnostic imaging, Clinical Laboratory Improvement Amendments number, and the Food and Drug Administration radiology certification number Expanded instructions for individual and group affiliations to […]

Have Your Patients Got New MBI (Medicare Beneficiary Identifier)?

The Centers for Medicare & Medicaid Services (CMS) is mailing the new Medicare cards with the (MBI) Medicare Beneficiary Identifier in phases by geographic location. There are 3 ways you and your office staff can get MBIs: Ask your Medicare patients: Ask your Medicare patients for their new Medicare card when they come for care. […]

Improved Acute Myocardial Infarction (AMI) Guidelines

ICD-10-CM implementation brought several significant changes to the OCG (Official Guidelines for Coding and Reporting) with regard to Chapter 9 (Diseases of the Circulatory System) I.C.9.e Acute myocardial infarction (AMI). Preparing yourself for coding updates based on MI type is not sufficient. You also must learn how to apply these new codes using OGC for […]

3 Ways for Health Care Providers to Get Patients MBIs

Medicare has come up with a new revelation this time. It is taking steps to remove Social Security numbers from Medicare cards. A health care providers also are any provider from whom the employee’s group health plan will accept medical certification to substantiate a claim for benefits. The initiative from Medicare, the Centers for Medicare […]

2019 NCCI update impact on medical billing and coding

NCCI – National Correct Coding Initiative promotes the correct coding methodologies. Furthermore, it controls inappropriate coding leading to wrong payments in Part B claims. The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services. The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool that […]

Evaluating Your Ambulance Transportation Medical Billing Procedure

Ambulance Transportation Medical billing has been under the lens of Medicare for a very long time due to the fabrication of medical charges and unreasonable billing rates for patients during an emergency. In September 2015, a report was released by the Office of Inspector General (OIG) after studying Medicare Part B Ambulance claims. The report […]

Acquaint Yourself with 9 New HCPCS Modifiers

A modifier is a two-digit numeric or alphanumeric character reported with an HCPCS Modifier code, when appropriate. Modifiers are designed to give Medicare and commercial payers additional information needed to process a claim. This includes HCPCS Level I (Physicians’ Current Procedural Terminology [CPT®]) and HCPCS Level II codes. A modifier provides the means by which […]

How to Avoid Common Medical Billing Compliance Pitfalls?

There are several major issues facing compliance officers today, such as HIPAA, Stark Law, and Anti-kickback Statute issues, as well as many billing compliance issues. Billing issues continue to appear in federal government False Claims Act settlement agreements and government audit reports. Here, we’ll discuss incident-to and shared billing compliance pitfalls and focus on what […]

Prior Authorization and It’s Impact on Practice Collection

Prior authorization is a check run by some insurance companies or third-party payers before they will agree to cover certain prescribed medications or medical procedures. There are a number of reasons that insurance providers require prior authorization, including age, medical necessity, the availability of a generic alternative, or checking for drug interactions. A failed authorization […]

Impact of High-Deductible Health Plans (HDHP) on Medical Practices

High-Deductible Health Plans (HDHP) have become increasingly popular since the Medicare Modernization Act of 2003 authorized portable, tax-advantaged health savings accounts (HSAs) designed to be coupled with these plans. Supports of HDHP advocate that, these plans as an effective mechanism for controlling health care costs by creating cost-conscious health care consumers who will look for […]

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