Medicare Coding & Billing

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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.

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.

Coding and Billing Information

Home Health Consolidated Billing Master Code List – An Excel workbook file containing complete lists of all codes ever subject to consolidated billing provision of HH PPS. A master list worksheet shows the dates each code was included and excluded from consolidated billing editing on claims, with associated CMS transmittal references. The master list also associates each code with any related predecessor and successor codes. Supplemental worksheets show the list of included codes for each CMS transmittal to date. See "Downloads" section below.

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 Billing, Medicare Eligibility and Enrollment

When someone is covered by another health insurance plan, Medicare can be classified as the secondary payer when the patient is covered by employee sponsored or other government administered plans. The primary plan must be billed first. Medicare claims must be submitted after the EOB has been received from the primary carrier. The EOB must be attached to the Medicare secondary claim with the applicable service dates and procedures clearly identified.

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Related posts:

  1. Coding and Billing Information
  2. Medical Billing and Coding Guidelines and tips to improve billing.: Medicare billing address
  3. Medical Billing and Coding
  4. Medical Billing and Coding
  5. Electronic Billing & EDI Transactions

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