ambulance billing service Archives

U.S. Healthcare System Addressing COVID-19 Patient Surge

Centers for Medicare & Medicaid Services (CMS) on 30th March 2020 issued 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. CMS sets and enforces essential quality and safety standards for the nation’s healthcare system, and […]

Medicare Coverage for DSMT Benefit

The Centers for Medicare & Medicaid Services (CMS) provides reimbursement for Medicare beneficiaries for diabetes self-management training (DSMT), under certain conditions. Becoming familiar with the Medicare DSMT reimbursement guidelines can help increase a DSMES service’s financial sustainability. Medicare Part B (medical insurance for outpatient care, preventive services, Ambulance Billing Services, and durable medical equipment) covers […]

ICD-10-CM Guidelines for Coding and Reporting FY 2020 – Obstetrics

The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government’s Department of Health and Human Services (DHHS) provide the guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). These guidelines should be used as a […]

ICD-10-CM Guidelines for Coding and Reporting FY 2020 – Respiratory System

Ground Ambulance Transports Coverage Requirements

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

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 […]

Top 5 Compliance Issues for Ambulance Biller

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 […]

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 […]

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 […]

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