Medicare Coding & Billing
New Physical Therapy Evaluation and Reevaluation CPT Codes PTs must begin using 3 new evaluation codes and a new reevaluation code beginning January 1, 2017. Now is the time to become familiar with them.
Electronic Billing & EDI Transactions
The information in this section is intended for the use of health care providers, clearinghouses and billing services that submit transactions to or receive transactions from Medicare fee-for-service contractors. EDI is the automated transfer of data in a specific format following specific data content rules between a health care provider and Medicare, or between Medicare and another health care plan. In some cases, that transfer may take place with the assistance of a clearinghouse or billing service that represents a provider of health care or another payer. EDI transactions are transferred via computer either to or from Medicare. Through use of EDI, both Medicare and health care providers can process transactions faster and at a lower cost. Please see pages on specific types of EDI conducted by Medicare for related links and downloads as applicable.
Medicare, Medicaid and Medical Billing
When a Part A claim is processed by Medicare, Medicare pays the provider directly for the service rendered by the provider. On the other hand, in a Part B claim, who pays depends on who has accepted the assignment of the claim. If the provider accepts the assignment of the claim, Medicare pays the provider 80% of the cost of the procedure, and the remaining 20% of the cost is passed on to the patient. You should recognized that 80-20 breakdown: it’s a classic example of coinsurance.
Medicare Billing, Medicare Eligibility and Enrollment
Medicare Part B claims are filed with the information required in the CMS-1500 claim format which is usually transmitted electronically. If you are in the process of enrolling a provider in Medicare, a helpful resource is Medicare Enrollment – Completing the 855i by Solutions Medical Billing. This guide explains the Medicare enrollment forms necessary to complete the Medicare enrollment application correctly. If you’ve ever tried to fill out Medicare forms, you know this can be a confusing and time consuming process. Having a good guide to explain it and walk you through it can save a lot of time and effort.