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Per Diem agreement and allowed amount calculation

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: •...

DRG Hierarchy and calculation of allowed amount

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...

Where Can I Check the Fee schedule for DME, physician fee?

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...

Policy Guideline for provider performed unlisted CPT code

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...

How much payment would get Assitant Surgeon, Co- Surgery and Team surgery

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...
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CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved to AMA.
The revenue codes and UB-04 codes are the IP of the American Hospital Association. All Rights Reserved to AMA.
All our content are education purpose only. All the articles are getting from various resources. If you find anything not as per policy. Please reach out and we would do the investigation and remove the article.
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