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 […]
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 details: Medicare Part B Medicare Part B covers emergency […]
Co-management compliance is tracking down by the U.S. Department of Health and Human Services OIG (Office of Inspector General). You should manage the patient’s transfer of care correctly as well as it must be medically acceptable (determination is made by the surgeon and the patient). Transfer of care is defined as a transfer of responsibility […]
Medicare covers wound care for all beneficiaries, irrespective that it is carried out in an inpatient or outpatient setting. It can be expensive for patients. Few people may suffer from post-surgical lesions. Other patients may suffer from chronic fungal or viral wounds. Due to the prevalence of wounds with age, it’s simple to understand why […]
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 […]
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 […]
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 […]
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. […]
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 […]