american healthcare billing services Archives

Medicare Covered Vision Services

Medicare Fee-For-Service/ original Medicare does not normally cover routine vision services, such as eyeglasses and eye exams. Medicare may cover some vision costs associated with eye problems resulting from an illness or injury. This article covers Medicare-covered vision services for certain beneficiaries, including Intraocular lenses (IOLs); Glaucoma screenings, and other Medicare-covered services. Generally, Medicare covers […]

Medicare Proposed Changes for 2020 Physician Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) is seeking to change its approach to paying clinicians for many office visits, incorporating recommendations and ideas from research done by the American Medical Association. Medicare also is pressing for greater disclosure to consumers about hospital prices and for the creation of incentives for dialysis centers to […]

Patients over Paperwork – CMS’s Approach to improve Patient Care

On 26th Sept 2019, the Centers for Medicare & Medicaid Services (CMS) is taking action at President Trump’s direction to “cut the red tape,” bringing relief to America’s healthcare providers by reducing unnecessary burden, allowing them to focus on their top priority – patients. The Omnibus Burden Reduction (Conditions of Participation) Final Rule strengthens patient […]

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

Quantifying Your Medical Decision-Making

Quantifying Cognitive Labor This is the most important of the three key components because the Medical Decision-Making (MDM) reflects the intensity of the cognitive labor performed by the physician. There are four levels of MDM of incrementally increasing complexity Straightforward; Low Complexity; Moderate Complexity; and High Complexity. Physicians must stratify the MDM into one of […]

New Medicare Beneficiary Identifiers (MBI)

MBIs are required for all claims and transactions starting Jan. 1, 2020 (with few exceptions). Out with the old Health Insurance Claim Numbers (HICNs) and in with the new Medicare Beneficiary Identifiers (MBIs) as beneficiaries receive updated cards in advance of a Jan. 1, 2020, transition. As of Aug. 19, the Centers for Medicare & […]

New Payment Model for Ambulance Services: ET3

The Department of Health and Human Services had launched a new payment model for ambulance services that federal officials believe could lower out-of-pocket costs for Medicare fee-for-service beneficiaries. The Emergency Triage, Treat, and Transport Model—ET3—allows ambulance companies to deliver on-the-scene or telehealth services to Medicare FFS patients, and transport them to alternative care venues, such […]

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 […]

Modifier 50 Fact Sheet

Modifier 50 applies to bilateral procedures performed on both sides of the body during the same operative session. When a procedure is identified by the terminology as bilateral or unilateral, the 50 modifiers are not reported. If a procedure is authorized for the 150 percent payment adjustment for bilateral procedures (payment policy indicator 1), […]

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