by Medical Billing | Aug 3, 2016 | Medicare payment basics
A Present on Admission (POA) Indicator is used to identify whether a primary or secondary condition was present at the time the order for inpatient admission occurs. Conditions that develop during an outpatient encounter, including emergency department, observation,...
by Medical Billing | Jul 31, 2016 | Medicare payment basics
Per Diem Per Diem is a per day negotiated rate which represents an allowance that includes all services for that day. Per Diem agreements reimburse based on the admission date of the member. The following terminology is used when referring to per diem contracts: •...
by Medical Billing | Jul 28, 2016 | Medicare payment basics
DRG Hierarchy for a Standard Base Agreement Each inpatient case for a DRG contract is evaluated using the following payment hierarchy: • Low Stay Outlier • High Charge/High Stay Outlier • DRG Value Inlier Once a claim meets the criteria for a step in the hierarchy...
by Medical Billing | Jul 25, 2016 | Medicare payment basics
Partial Hospitalization • Submit partial hospitalization services with the following revenue codes: • 0912, 0913 or 0915 o If a separate contract for the hospital and psych DPU are in effect, submit partial hospitalization services and inpatient services on separate...
by Medical Billing | Jul 3, 2016 | Medicare payment basics
When billing home health services to Florida Blue, revenue codes and CPT/HCPCS should be reported using the most current publications. The matrix below indicates the commonly used the revenue codes to be used in billing home health/home infusion services. • Multiple...