by Medical Billing | Nov 6, 2016 | Medicare payment basics
Can I appeal an outpatient therapy threshold prior authorization decision? Answer: When a service provided beyond the thresholds is determined to be not medically necessary through prior authorization and/or pre-payment review of the claim, it is denied as a benefit...
by Medical Billing | Oct 26, 2016 | Medicare payment basics
Revenue Codes • Skilled Nursing o 0551 – visit charge o 0552 – hourly • Indicate “21X”, “22X” or “23X” in type of bill field, which is field 4 for paper claims. o First digit – Type of facility (2) o Second digit – Bill classification (inpatient – 1,...
by Medical Billing | Jul 13, 2016 | Medicare payment basics
Type of bill (211-214) Revenue code (0191-0194, 0199) • Level 1 (Revenue Code 0191) • Level 2 (Revenue Code 0192) • Level 3 (Revenue Code 0193) • Level 4 (Revenue Code 0194) • Level 5 (Revenue Code 0199) • All per diem rates will include, but may not be limited to the...
by Lori | Aug 26, 2015 | Medicare payment basics
To qualify for Medicare Part A coverage of SNF services, the following conditions must be met: ◘ The beneficiary was an inpatient of a hospital for a medically necessary stay of at least 3 consecutive days; ◘ The beneficiary transferred to a participating SNF within...