by purush167 | Feb 9, 2023 | Medicare payment basics
How to Identify Members When members arrive at your office, remember to ask to see their current member identification (ID) cards at each visit. This will help you identify the product the member has and get dental plan contact information. It will also help you with...
by purush167 | Dec 10, 2022 | Medicare payment basics
MANAGEMENT INFORMATION SYSTEM (MIS) A. The MCO shall operate the MIS capable of maintaining, providing, documenting, and retaining information sufficient to substantiate and report MCO’s compliance with the n contract requirements. The MCOs must maintain current...
by purush167 | Nov 21, 2022 | Medicare payment basics
TRANSITIONING/TRANSFERRING OF ENROLLEES A. Transitioning Recipients into MCOs The MCO will be responsible for enrollees as soon as they are enrolled and the MCO is aware of the enrollee in treatment. The MCO must have policies and procedures for transitioning...
by purush167 | Oct 8, 2022 | Medicare payment basics
Overview of the Patient-Driven Groupings Model The Patient-Driven Groupings Model (PDGM) uses 30-day periods as a basis for payment. Figure 1 below provides an overview of how 30-day periods are categorized into 432 case-mix groups for the purposes of adjusting...
by purush167 | Sep 13, 2022 | Medicare payment basics
Introduction – WCMSA If you have decided to self-administer your CMS-approved Workers’ Compensation Medicare Set-Aside Arrangement (WCMSA), this Toolkit can help you manage your account appropriately and satisfy Medicare’s interests related to future medical...
by purush167 | Aug 24, 2022 | Medicare payment basics
Overview of Medicare Cost Reports Institutional providers certified by the Medicare program are required to submit cost reports to Medicare Administrative Contractors (MACs) annually (Centers for Medicare and Medicaid Services [CMS], 2016). CMS makes cost report data...
by purush167 | Jul 3, 2022 | Medicare payment basics
HPV Vaccination CPT CODES There are three different CPT® codes developed for reporting of HPV vaccination: 90649 Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use 90650 Human Papillomavirus vaccine, types...
by purush167 | Jun 4, 2022 | Medicare payment basics
Reporting a WC Case All WC occurrences that involve a Medicare beneficiary should be reported to the Benefits Coordination & Recovery Center (BCRC). If you are a Responsible Reporting Entity (RRE) making an initial report of ongoing responsibility, use the Section...
by purush167 | May 23, 2022 | Medicare payment basics
CPT CODE AND Description 91311 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use Administration codes 0111A Immunization...
by purush167 | Apr 12, 2022 | Medicare payment basics
Check out these five facts if you’d like to boost your claims success rate. Point 1: Check the LCD Guidelines Although emergency department coders are usually very diligent about knowing which ICD-10-CM codes to submit to payers, sometimes important diagnosis coding...
