Medicare won’t provide coverage for items and services that are not reasonable and necessary for the diagnosis or treatment of an illness or injury. National coverage determinations (NCDs) are made through an evidence-based process, with opportunities for public participation. In the absence of NCDs, an item or service may be covered at the discretion of […]
CMS’s Proposed Rule on Automating Prior Authorization On 10th December 2020, The Centers for Medicare & Medicaid Services (CMS) proposed a new regulation aimed at improving the sharing of healthcare data between payers and providers and streamlining, a major administrative hassle for providers. This new rule will boost patient data exchange and streamline which will […]
A crossover claim is a claim for a recipient who is eligible for both Medicare and Medicaid, where Medicare pays a portion of the claim, and Medicaid is billed for any remaining deductible and/or coinsurance. A Coordination of Benefits Contractor (COBC) is used to electronically, automatically cross over claims billed to Medicaid for eligible recipients. […]
The American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS) has announced guideline and code descriptor changes for outpatient E/M services to be effective from Jan. 1, 2021. These changes will be applicable only to office or other outpatient E/M codes (99202-99215); all other E/M services will remain unchanged. Till the year […]
Basics of Worker’s Compensation Worker’s compensation, commonly known as worker’s comp, is a type of insurance that covers the treatment of injuries occurring on the job. Employers typically purchase commercial worker’s comp policies directly, although some states administer these policies. Medical billers must therefore remain aware of the worker’s comp policies for their state, including […]
Providers seeing a 2 percent payment decrease on their Remittance Advice (RA) is due to a mandatory sequestration payment reduction. Claim adjustment reason code (CARC) 253 is used to report the sequestration reduction. The code will appear as a CO 253 on the RA ‘Sequestration-reduction in federal payment’ as the reason. For the Medicare Fee-for-Service […]
Insurance will deny the claim with denial code CO 29 – the time limit for filing has expired, whenever the claims submitted after the time frame. The time limit is calculated from the date service provided. Each insurance carrier has its own guidelines for filing claims in a timely fashion. Some are as short as […]
You might have received a denial with claim adjustment reason code (CARC) CO B9. Possible reasons for this denial message could be: The patient is enrolled in Hospice on the date of service Medicare Part B only pays for physician services not related to Hospice condition and not paid under arrangement with Hospice entity Patient’s […]
Medical nutrition therapy (MNT) is a key component of diabetes education and management. MNT is defined as a ‘nutrition-based treatment provided by a registered dietitian nutritionist.’ It includes ‘a nutrition diagnosis as well as therapeutic and counseling services to help manage diabetes. Studies have documented an association between MNT delivered by a registered dietitian and […]
CMS recently announced that it will provide parity in payment for telephone/audio-only services. Specifically, Medicare payment for the telephone evaluation and management visits would be equivalent to Medicare payment for office/outpatient visits with established patients’ effective March 1, 2020. This means that payment for CPT codes 99441-99443 would increase from a range of about $14-$41 […]
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