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why post payment audit happening in insurances

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...

Psychiatric and Substance Abuse Facilities

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...

Inpatient Hospital Requirements – DRG and Per Diem concept

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...

What is Clinical trials and well child care

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...

Present of Admission (POA) Indicator list on UB 04

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...
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CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved to AMA.
The revenue codes and UB-04 codes are the IP of the American Hospital Association. All Rights Reserved to AMA.
All our content are education purpose only. All the articles are getting from various resources. If you find anything not as per policy. Please reach out and we would do the investigation and remove the article.
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