by Medical Billing | Aug 17, 2013 | Medicare payment basics
Credentialing Credentialing is the process by which the appropriate committee reviews documentation for each individual physician/provider to determine participation in the health plan network....
by Medical Billing | Aug 6, 2013 | Medicare payment basics
Complaint: Any expression of dissatisfaction by a Member, including dissatisfaction with the administration, claims practices, or provision of services, which related to the quality of care provided by a provider pursuant to the organization’s contract and which is...
by Medical Billing | Oct 22, 2012 | Medicare payment basics
NONPHYSICIAN PRACTITIONERS (NPP) means physician assistants, clinical nurse specialists, and nurse practitioners, who may, if state and local laws permit it, and when appropriate rules are followed, provide, certify or supervise therapy services. PHYSICIAN with...
by Medical Billing | Oct 17, 2012 | Medicare payment basics
The EPISODE of Outpatient Therapy – For the purposes of therapy policy, an outpatient therapy episode is defined as the period of time, in calendar days, from the first day the patient is under the care of the clinician (e.g., for evaluation or treatment) for the...
by Medical Billing | Oct 11, 2012 | Medicare payment basics
ACTIVE PARTICIPATION of the clinician in treatment means that the clinician personally furnishes in its entirety at least 1 billable service on at least 1 day of treatment. ASSESSMENT is separate from evaluation, and is included in services or procedures, (it is not...