For Medicare, modifiers are 2-digit codes that are appended to procedural codes and HCPCS codes. These modifiers are used to give more details about the billed procedure. The addition of modifiers in a claim can directly impact payment. You can get a list of modifiers on the internet at any time where you will get […]
Federal Register announced in their notice that a 1-year extension of the Medicare Prior Authorization Model for Repetitive Scheduled Non-Emergent Ambulance Transport. The extension of this model is applicable in certain states only. Earlier in those states, ambulance suppliers must obtain prior authorization from Medicare before providing scheduled, non-emergency ambulance transportation. These states are: Delaware […]
Recently, the Secretary of the Department of Health and Human Services (HHS) determined, according to section 564 of the Federal Food, Drug and Cosmetic (FD&C) Act, that there is a public health emergency, which has a serious potential to influence the health as well as the national security of citizens of the U.S. staying in other […]
The Trump Administration is issuing an unprecedented array of temporary regulatory waivers and new rules to equip the American healthcare system with maximum flexibility to respond to the 2019 Novel Coronavirus (COVID-19) pandemic. Made possible by President Trump’s recent Ambulance emergency declaration and emergency rulemaking, these temporary changes will apply immediately across the entire U.S. […]
All of these coverage requirements apply to ground ambulance transports: The Transport Is Medically Reasonable and Necessary A medically reasonable and necessary ground ambulance transport must meet these requirements: Medical necessity is established when the patient’s condition is such that the use of any other method of transportation is contraindicated. In any case in which […]
Ambulatory Surgical Center Terminated Procedures The following guidance determines the appropriate ambulatory surgical center (ASC) facility payment for a scheduled surgical procedure that is terminated due to medical complications, which increase the surgical risk to the patient. Payment is denied when an ASC submits a claim for a procedure that is terminated before the patient […]
Ambulance service billing involves a host of unique compliance challenges. The ambulance industry has seen a significant number of false claim cases, fraud investigations, Medicare audit activity, and other types of billing-related cases. It is imperative that billers fully understand the nuances of ambulance reimbursement to be able to successfully sidestep these landmines. The following […]
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 […]
With the tremendous changes in the health care industry, it is going evolving with new rules and regulations to match up with the people’s expectations and demands. It is one of the biggest transition phases wherein the independent practices are transforming their independent practices to value-based care ASC Billing Facilities. Ambulatory surgery centers (ASCs) are […]
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