PAR and non-PAR Providers with Medicare The Center for Medicare & Medicaid Services (CMS) is a federal agency within the Department of Health and Human Services which manages and oversees the Medicare program for beneficiaries. Physicians are required to comply with numerous laws and regulations related to various aspects of their practice within the Medicare […]
Basics of Obesity Screening and Counseling Obesity screening and counseling are one of many 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 for obesity […]
Managed Care plays important role in the delivery of healthcare and it is used to describe a health insurance plan or health care system that coordinates the provision, quality, and cost of care for its enrolled members. Traditionally States have utilized a fee-for-service (FFS) payment system to cover enrollees but now states are also making […]
Today various private and public ambulance transport services are operating in a huge number for servicing critical patients at crucial moments. These players are getting reimbursed under Medicare Part B which covers ambulance transport medical billing with certain limitations. Let’s understand Medicare Part B in more detail: Medicare Part B Medicare Part B covers emergency […]
An Assistant at Surgery is a provider who actively assists the physician in charge of a case in performing a surgical procedure. A physician, nurse practitioner, physician assistant, or clinical nurse specialist who is authorized to provide such services under state law can serve as a surgery. Medicare considers advanced registered nurse practitioners (ARNP), physician […]
If your Medicaid crossover claims are rejecting it may be due to the address you have on file with Medicare and Medicaid. When Medicare crosses over your claim to Medicaid, address fields like Master address and Pay-to (or remit address) are submitted. If Medicaid does not have the same addresses in their file, Medicaid will […]
A healthcare facility’s accountability and overall reputation is dependant upon Physician Credentialing. If there is one administrative task that requires meticulousness and painstaking precision in a healthcare sector, it is physician credentialing. Being a process that is so stringent and directly impacts reimbursements, credentialing is a complete nightmare for those facilities where the administrative staff […]
PECOS is the short form for Provider, Enrollment, Chain, and Ownership System. It is a database where doctors register with the Centers for Medicare and Medicaid Services (CMS). It is a national electronic database for recording and retaining data on Medicare-enrolled providers and suppliers. CMS developed PECOS as a mechanism to combat fraud and abuse. PECOS […]
Loss of Protective Sensation (LOPS) Basics Diabetic sensory neuropathy, or peripheral neuropathy, is the most common factor leading to amputation in people with diabetes. In diabetes, sensory neuropathy is an anatomically diffuse process primarily affecting autonomic and sensory fibers; however, distal motor findings may be present in advanced cases. Long nerves are affected first, with […]
The Centers for Medicare & Medicaid Services (CMS) on 2nd October 2020, finalized policies that allow certain new and innovative equipment and supplies used for dialysis treatment of patients with End-Stage Renal Disease (ESRD) in the home to qualify for an additional Medicare payment. This final rule encourages the development of new and innovative home […]
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