Mandatory Accept Assignment on Medicare and HMO Claims
The following practitioners who provide services under the Medicare program are required to accept assignment for all Medicare claims for their services. This means that they must accept the Medicare...
View ArticleHow much amount can physician collect from patient before the service rendered?
Physician’s Right to Collect From Enrollee on Assigned Claim Submitted to Carriers Before the Claim is Submitted The provider (including physicians and suppliers) who is accepting assignment should...
View ArticleWhat happen to the claims if accept assignment is not marked in participating...
Processing Claims for Services of Participating Physicians or Suppliers by Carriers The participating physician or supplier submits any claims for services furnished by the physician or supplier,...
View ArticleDo we need show the amount collected from patient in CMS 1500 form?
By law, yes. we should show the it in the form and infact that reduce physician work of refunding the excess payment and other work related on that process.Failing to do so and medicare receives many...
View ArticleEffect of Assignment Upon Rental or Purchase of Durable Medical Equipment on...
Equipment More Expensive Than Standard Item An item of durable medical equipment may have certain convenience or luxury features that make it more expensive than a standard item, i.e., one which...
View ArticleMedicare schedule update - Important steps and dates involved in every year
Key Implementation Dates A detailed schedule of key implementation dates will be provided in an annual temporary instruction in advance of receiving the MPFS Database file. The following outlines...
View ArticleWhat is limiting charges - with example
Carrier Rules for Limiting Charge Effective January 1, 1991, the maximum allowable actual charge (MAAC) for non- participating physicians is replaced by the limiting charge. The limiting charge is the...
View ArticleCharges for Missed Appointments
CMS's policy is to allow physicians and suppliers to charge Medicare beneficiaries for missed appointments, provided that they do not discriminate against Medicare beneficiaries but also charge...
View ArticleChange of Ownership - Procedure to follow
When an organization having a provider agreement undergoes a change of ownership in accordance with the principles articulated in 42 CFR Part 489 and §3210 of the State Operations Manual, the agreement...
View ArticleWhat is Incomplete or Invalid Submissions
Services not submitted in accordance with CMS instructions include: • Incomplete Submissions - Any submissions missing required information (e.g., no provider name). • Invalid submissions - Any...
View ArticleBasic of Handling of Invalid claim submission
Handling Incomplete or Invalid Submissions The following provides additional information detailing submissions that are considered incomplete or invalid. The matrix in Chapter 25 specifies whether a...
View ArticleWhat is Medicare connection
About the Medicare B ConnectionThe Medicare B Connection is a comprehensive publication developed by First Coast Service Options Inc. (First Coast) for Part B providers in Florida, Puerto Rico, and the...
View ArticleMedicare overpayment denial - what should provider do ?
Medicare E/M claims for new patientsAs previously announced with MM8165, Medicare implemented a common working file system edit to identify claims where more than one new patient visit was billed for...
View ArticleDoes Medicare require pre authorization for therapy services
Pre-approval requests for therapy servicesFirst Coast is continuing to receive the form “Request for pre-approval of therapy services above the $3700 threshold” for prior authorization of therapy...
View ArticleMedicare Enrollment denials when overpayment exists with example
What you need to knowThis article, based on CR 8039, informs you that Medicare contractors may deny a Form CMS-855 enrollment application if the current owner of the enrolling provider or supplier or...
View ArticleMedicare rejection - Accident date is required and rendering provider required
An accident date is required for Federal program when an accident related diagnosis is present.What this means: Some claims to this payer may reject for 'An accident date is required for Federal...
View ArticleMedicare rejection or Audit for incorrect POS
Common Working File (CWF) Informational Unsolicited Response (IUR) or Reject for Place of Service Billed by Physician Office and either Ambulatory Surgical Center or Inpatient Hospital The Medicare...
View ArticleMedicare EOB sequestration payment reduction code CO 253
New Claim Adjustment Reason Code (CARC) to Identify a Reduction in Payment Due to Sequestration This article is based on CR 8378 which informs Medicare contractors about a new Claim Adjustment Reason...
View ArticleBCBS insurance id starts with VMB, VMA, XJQ, XJX and VME
How will our office recognize an Exchange member?Our member identification (ID) cards will not change. However, there will be new alpha prefixes on ID cards for Exchange members:VMB = Individual HMOVMA...
View ArticleHow much is Medicaid copay - out of pocket and what are the exemption cases
Beginning January 1, 2014, some services will be assigned copay amounts for Medicaid Members. The following copays will apply to claims with a date of service on or after January 1, 2014: Service TIER...
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