Billing Medicare for Initial Preventive Physical Examination

Initial Preventive Physical Examination (IPPE) The initial preventive physical examination (IPPE) is a preventive visit also known as a ‘Welcome to Medicare Preventive Visit’. Medicare pays for one IPPE per beneficiary per lifetime for beneficiaries within the first 12 months of the effective date of the beneficiary’s first Part B coverage period. The IPPE may […]

Selecting E&M Based on Time

Prior to 2021, the time associated with CPT codes 99202-99215 was based specifically on the typical face-to-face time the physician/qualified health care professional (QHP) spent on the day of the encounter. After 2021, providers may select the level of office and outpatient evaluation and management (E&M) services based on either time or medical decision-making. In […]

Basics of Medicare Remittance Advice (RA)

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 […]

Basics of EDI Enrollment with Medicare FFS

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 and Telehealth Coverage after the End of PHE

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 […]

Medicare R&N Requirements for Glucose Monitors

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 Financial Health of Your Practice

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 […]

Most Favored Nation (MFN) Model

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 […]

Beginners Guide for Billing Therapy Care

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. Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. We keep on […]

Understanding Medicare Recovery Audit Contractor (RAC) Audit

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. […]

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