SNF Advanced Beneficiary Notice of Non-coverage Medicare requires SNFs to issue the SNFABN to Original Medicare, also called fee-for-service (FFS), beneficiaries prior to providing care that Medicare usually covers, but may not pay for in this instance because the care is not medically reasonable and necessary; or considered custodial. The SNFABN provides information to the […]
The A/B Medicare Administrative Contractors (A/B MACs), and Durable Medical Equipment Medicare Administrative Contractors (DME MACs) send to providers, physicians, and suppliers, as a companion to claim payments, a notice of payment, referred to as the Remittance Advice (RA). RAs explain the payment and any adjustment(s) made during claim adjudication. For each claim or line […]
What is EDI Enrollment? For a provider is trying to enroll with Medicare FFS, they must first establish an Electronic Data Interchange (EDI) agreement with Medicare. EDI is the process of using nationally established standards to exchange electronic information between business entities. The Department of Health and Human Services (HHS) adopted certain electronic standards for […]
Medicare, Medicaid, and private payers had relaxed their billing guidelines and revised reimbursement policies so that physicians can provide better care during the COVID-19 pandemic. A Public Health Emergency (PHE) was declared for the same by the federal government. In March 2020, a public health emergency (PHE) declaration was issued under Section 201 of the […]
Home blood glucose monitors (BGMs) and continuous glucose monitors (CGMs) are covered under the Durable Medical Equipment (DME) benefit. In order for a beneficiary’s DME to be eligible for reimbursement, the reasonable and necessary (R&N) requirements set out in the related Local Coverage Determination (LCD) must be met. In addition, there are specific statutory payment […]
Keeping track of the financial health of your practice is important for many reasons. On the most basic of levels, it allows you to keep the doors open. You can retain your staff, keep their morale high and remove the headaches associated with worrying about money month to month. Most importantly, though, it allows you […]
As an attempt to lower drug costs, the Centers for Medicare & Medicaid Services (CMS) released an interim final rule that implements a new payment model, known as the Most Favored Nation (MFN) Model. Its approach is to pay no more for high-cost Medicare Part B drugs and biologicals than the lowest price that drug […]
Orthopedic surgeons are increasingly incorporating physical and occupational therapy services into their practices. In-house billers, who may be inexperienced with the new services, terminology, and associated CPT codes, may be unsure about billing for therapy care. MedicalBillersandCoders (MBC) is a leading medical billing company providing complete revenue cycle services. We keep on sharing billing and […]
What is Recovery Audit Contractor (RAC) Audit? As a combined effort to fight fraud, waste, and abuse in the Medicare program, Recovery Audit Contractor (RAC) audit was in place from January 1, 2010. The goal of the recovery audit contractor program is to identify improper payments made on claims for services provided to Medicare beneficiaries. […]
Basics of Obesity Screening and Counseling Obesity screening and counseling are one of a number of distinct preventive services mandated by national and state regulations (US Dept. of Labor). The U.S. Preventive Services Task Force (USPSTF) recommends screening all adults for obesity this screening also includes children of >6 years old. CMS began reimbursing physicians […]