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 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...
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...
