by Medical Billing | Apr 20, 2017 | Medicare payment basics
New Therapy Cap Process: Frequently Asked Questions What is the new Therapy Cap process? Answer: Starting October 1, 2012, claims for patients who meet or exceed $3,700 in therapy expenditures will be subject to prior authorization. For outpatient therapy...
by Medical Billing | Jun 8, 2016 | Medicare payment basics
QUESTIONS AND ANSWERS 1 Q: If a patient is seen in the office at 3:00 p.m. and admitted to the hospital at 1:00 a.m. the next day, may both the office visit and the initial hospital care be reported? A: Yes. Because different dates are involved, both codes may be...
by Medical Billing | Jun 5, 2016 | Medicare payment basics
In the inpatient hospital setting all physicians (and qualified nonphysician practitioners where permitted) who perform an initial evaluation may bill the initial hospital care codes (99221 – 99223) or nursing facility care codes (99304 – 99306). Contractors consider...
by Medical Billing | May 15, 2016 | Medicare payment basics
Overview Some services or procedures performed by providers might not have specific Current Procedure Codes (CPT) or HCPCS codes. When submitting claims for these services or procedures that are not otherwise specified, unlisted codes are designated. Unlisted codes...
by Medical Billing | Apr 21, 2016 | Medicare payment basics
Assistant Surgeon Services Harvard Pilgrim reimburses assistant surgeon services when the assistant at surgery is a physician, a physician assistant, or a nurse practitioner consistent with CMS’ determination of approved procedure codes payable to an assistant...
