Workers’ compensation billing is the process of billing an employer’s workers’ comp insurer, not the patient’s health plan, for treatment of a work-related injury or illness. Providers submit a CMS-1500 claim with the date of injury, the workers’ comp claim number, and supporting documentation, and follow fee schedules set by each state’s compensation board. Workers’ […]
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 […]
Timely filing (CO 29) denials are handled in one of two ways: prove the claim reached the payer inside the filing window, or appeal with a valid, documented reason for the delay. CO 29 means the payer’s time limit for filing has expired, and that limit runs from the date of service. Insurance will deny […]
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 […]
Handling denial B9 with modifiers GV and GW starts with confirming the patient was enrolled in hospice on the date of service, then adding the modifier that fits the service. GV applies when an attending physician who is not employed or paid by the hospice treats the terminal condition, and GW applies when the service […]
Medical nutrition therapy (MNT) is a key component of diabetes education and management. MNT is defined as a ‘nutrition-based treatment provided by a registered dietitian nutritionist.’ It includes ‘a nutrition diagnosis as well as therapeutic and counseling services to help manage diabetes. Studies have documented an association between MNT delivered by a registered dietitian and […]
Under some circumstances, the individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient’s condition. In these cases, the additional physicians are not acting as assistants at the surgery. […]
It’s an ideal industry practice that everyone who does medical coding (including physicians who code their own work) should have a periodic audit or ‘peer review’ to assure that their skill levels remain high and accurate. Accurate medical coding has a crucial role in healthcare information management and overall quality of care. Although Medical Billers […]
CMS recently announced that it will provide parity in payment for telephone/audio-only services. Specifically, Medicare payment for the telephone evaluation and management visits would be equivalent to Medicare payment for office/outpatient visits with established patients’ effective March 1, 2020. This means that payment for CPT codes 99441-99443 would increase from a range of about $14-$41 […]
If you are a provider and you are going to start the credentialing process then you need to read this provider credentialing issue in healthcare. We observed that there are many potential issues and potential costs in the provider credentialing process. Actually, provider credentialing is the most important compliance issue in medical practice. Without credentialing […]
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