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Avoid Common Errors in Ambulance Transportation Billing

Avoid Common Errors in Ambulance Transportation Billing

An ambulance is a part of Emergency Medical Services (EMS), which is a billable event and most of the insurance companies such as Medicaid and Medicare compensate for it. Billing and coding for ambulance services may be complex owing to different modes of transportation like air, water, and ground. Apart from this, reimbursement of ambulance […]

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Ambulatory Surgical Centers-Progressive Model for Surgical Services

Ambulatory Surgical Centers-Progressive Model for Surgical Services

Ambulatory Surgical Centers (ASC) one of the fastest-growing medical services today that offers patients the opportunity to have selected surgical and procedural services performed outside the hospital setting. Physicians have contributed to the development of ASCs and they have the opportunity to directly control their surgical practices if they operate in ASCs as compared to […]

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Broadening Telehealth Coverage for Medicaid and CHIP

Broadening Telehealth Coverage for Medicaid and CHIP

Trump Administration on 23rd April 2020, released a new toolkit for states to help accelerate the adoption of broader telehealth coverage policies in the Medicaid and Children’s Health Insurance Programs (CHIP) during the 2019 Novel Coronavirus (COVID-19) pandemic. This release builds on the agency’s swift actions to provide states with a wide range of tools […]

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Medicare Increases Payment for High-Production Coronavirus Lab Tests

Medicare Increases Payment for High-Production Coronavirus Lab Tests

This announcement made by CMS-Rulings on 14th April 2020. CMS-Rulings provide clarification and interpretation of complex or ambiguous statutory or regulatory provisions relating to Medicare, Medicaid, Utilization and Quality Control Peer Review, private health insurance, and related matters. This Ruling articulates CMS policy concerning the designation and payment of certain clinical diagnostic laboratory tests related […]

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Maximizing Support to Medicaid and CHIP during COVID-19

Maximizing Support to Medicaid and CHIP during COVID-19

Trump Administration on 22nd April 2020, released new tools to strip away regulatory red tape and unleash new resources to support state Medicaid and Children’s Health Insurance Programs (CHIP) during the 2019 Novel Coronavirus (COVID-19) outbreak. Because of the President’s bold action in declaring COVID-19 a national emergency, CMS now has a full suite of […]

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CMS Guidance for Laboratories during COVID-19 Emergency

CMS Guidance for Laboratories during COVID-19 Emergency

CMS is committed to taking critical steps to ensure America’s clinical laboratories are prepared to respond to the threat of 2019 Novel Coronavirus (COVID-19) and other respiratory illnesses to ensure reliable testing as well as ensuring patient health and safety. CMS is issuing this guidance to laboratory surveyors to provide important guidance to surveyors and […]

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Adult Elective Surgery and Procedures Recommendations during COVID-19

Adult Elective Surgery and Procedures Recommendations during COVID-19

To aggressively address COVID-19, CMS recognizes that the conservation of critical resources such as ventilators and Personal Protective Equipment (PPE) is essential, as well as limiting exposure of patients and staff to the SARS-CoV-2 virus. The following recommendations are guidance to limit non-essential adult elective surgery and medical and surgical procedures, including all dental procedures. […]

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Prior authorization (PA) Policy Changes related to COVID-19

Prior authorization (PA) Policy Changes related to COVID-19

The information Prior authorization and guidance provided in this document are believed to be current and accurate at the time of posting this article. Major Medical Insurance Plans Plan Effective Date(s) Policies Aetna Check the Aetna COVID-19 Communications Update for state-specific information and detailed requirements 3/25/20 – 5/6/20 Transfers: Initial PAs waived in the following […]

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Medicare Fee-for-Service (FFS) Billing for COVID-19 Specimen Collection

Medicare Fee-for-Service (FFS) Billing for COVID-19 Specimen Collection

As part of the Public Health Emergency (PHE) for the COVID-19 pandemic and in an effort to be as expansive as possible within the current authorities to have diagnostic testing available to Medicare beneficiaries who need it, in the interim final rule with comment period, CMS is changing the Medicare Fee-for-Service (FFS) Billing rules during […]

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Modifier -25 for Minor Retina Surgeries

Modifier -25 for Minor Retina Surgeries

The growth of intravitreal drug therapy for the treatment of retinal diseases over the past decade has been unprecedented. The number of intravitreal injections performed annually in the United States rose from less than 3000 in 1999 to more than 1 million in 2008, and it is estimated that more than 7 million intravitreal injections […]

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