by Medical Billing | May 9, 2018 | Medicare payment basics
POST-PAYMENT AUDITS BCBSKS conducts periodic post-payment audits of patient records and adjudicated claims to verify congruence with BCBSKS medical and payment policies, including medical necessity and established standards of care. Post-payment audits can range from...
by Medical Billing | Nov 30, 2016 | Medicare payment basics
The information in this section pertains to members with PPO (BlueChoice, BlueMedicare PPO, and BlueOptions) and Traditional coverage. Note: All behavioral health services for HMO members should be arranged through New Directions Behavioral Health, including...
by Medical Billing | Nov 3, 2016 | Medicare payment basics
Inpatient services are generally reimbursed based on one of the following: • DRG, or • Per Diem Outlined below are generally accepted billing guidelines. This is intended to be illustrative and is not an all-inclusive list. • The Admission Date field should reflect...
by Medical Billing | Aug 8, 2016 | Medicare payment basics
Clinical Trials CMS has specific billing requirements for Clinical Trials. For clinical trials other than IDE A and B devices and Clinical Evidence Development, traditional Medicare A or B will pay primary, waiving any deductible. To ensure claims are processed...
by Medical Billing | Aug 5, 2016 | Medicare payment basics
The table below outlines the payment implications for each of the different POA Indicator reporting options. POA Indicator Options and Definitions Code Description Y Diagnosis was present at time of inpatient admission. Florida Blue will pay the...
