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 | May 18, 2016 | Medicare payment basics
Q. Where can I find fee schedules for my location and line of business? A. Select your location (Florida, Puerto Rico, or the U.S. Virgin Islands) and line of business (Part A or Part B) on the homepage of the First Coast Service Options (First Coast) Medicare...
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...