A crossover claim is a claim for a recipient who is eligible for both Medicare and Medicaid, where Medicare pays a portion of the claim, and Medicaid is billed for any remaining deductible and/or coinsurance. A Coordination of Benefits Contractor (COBC) is used to electronically, automatically cross over claims billed to Medicaid for eligible recipients. […]
The American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS) has announced guideline and code descriptor changes for outpatient E/M services to be effective from Jan. 1, 2021. These changes will be applicable only to office or other outpatient E/M codes (99202-99215); all other E/M services will remain unchanged. Till the year […]
Basics of Open Fracture Debridement Debridement is used to remove foreign material or damaged, dead, or contaminated tissue from a surgical field, wound, or injury. Debridement is used to promote healthy healing of damaged skin, tissue, muscle, or bone. The debridement of small amounts of devitalized or granulation tissue during a surgical procedure is typically […]
You just graduated from a school of optometry and decided on your practice location. If you Vision plan on examining patients who wish to use their vision and medical insurance, you must be an ‘in-network provider’ with that insurance company. According to the US Census Bureau, over 83 percent of the US population has health […]
Credentialing has become crucial for medical practices to survive in an increasingly volatile and competitive industry. Most American citizens today are covered by an insurance plan provided by some company or the other. If you fail to get credentialed with the insurance companies, then you will lose clients to your competitors. Hence, having the knowledge […]
Basics of Worker’s Compensation Worker’s compensation, commonly known as worker’s comp, is a type of insurance that covers the treatment of injuries occurring on the job. Employers typically purchase commercial worker’s comp policies directly, although some states administer these policies. Medical billers must therefore remain aware of the worker’s comp policies for their state, including […]
Providers seeing a 2 percent payment decrease on their Remittance Advice (RA) is due to a mandatory sequestration payment reduction. Claim adjustment reason code (CARC) 253 is used to report the sequestration reduction. The code will appear as a CO 253 on the RA ‘Sequestration-reduction in federal payment’ as the reason. For the Medicare Fee-for-Service […]
Insurance will deny the claim with denial code CO 29 – the time limit for filing has expired, whenever the claims submitted after the time frame. The time limit is calculated from the date service provided. Each insurance carrier has its own guidelines for filing claims in a timely fashion. Some are as short as […]
Credentialing is a systematic approach to the collection and verification of a healthcare provider’s professional qualifications. The qualifications that are reviewed and verified include, but are not limited to, relevant training, licensure, certification and/or registration to practice in a health care field, and academic background. Insurance credentialing is the process of becoming affiliated with insurance […]
You might have received a denial with claim adjustment reason code (CARC) CO B9. Possible reasons for this denial message could be: The patient is enrolled in Hospice on the date of service Medicare Part B only pays for physician services not related to the Hospice condition, and not paid under an arrangement with the […]
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