Medicare Secondary Payer (MSP) Group Health Plan (GHP) Working Aged Policy--...
Provider Action NeededSection 3 of the Defense of Marriage Act (DOMA) provided for purposes of federal law, the term “spouse” could not include individuals in a same-sex marriage. Because the MSP...
View ArticleMedicare Participating Provider versus Non-Participating Provider
Key Points/Instruction/What you need to knowParticipating ProviderNon-Participating ProviderA participating provider is one who voluntarily and in advance enters into an agreement in writing to provide...
View ArticleRailroad Medicare Beneficiaries to the Flu Season
It’s that time – time to get your flu vaccination. Medicare Part B (Including Railroad Medicare) normally pays for one flu vaccination per flu season (can be in the winter or in the fall). The flu...
View ArticleDon't Forget Covered Medicare Preventive Services
It’s time to take care of you. You can do this by taking advantage of the preventive and screening services that Medicare covers. These services can help keep you healthy. Ask your doctor which of...
View ArticleMedicare Preventive Visit, the Annual Wellness Visit and Routine Physical...
When you go to the doctor for a once-a year examination, it’s important that both you and your doctor know what kind of exam you are there for.Medicare pays for a one-time ‘Welcome to Medicare’...
View ArticleMedicare non covered items and services - part 1
THE FOUR CATEGORIES OF ITEMS AND SERVICES THAT ARE NOT COVERED UNDER THE MEDICARE PROGRAM AND APPLICABLE EXCEPTIONSThe following four categories of items and services that are not covered under the...
View ArticleWhen Medicare Pays First, Second or Even Third
When Medicare began in the 1960s, it was the primary payer for all services except those covered by workers compensation. Then in 1980, Congress enacted provisions to shift costs from the Medicare...
View ArticleMedicare as secondary payer - Full details
When Medicare As Secondary PayerUntil 1980, Medicare was the primary payer for all Medicare covered services except for services covered by workers' compensation or black lung benefits or paid for by...
View ArticleMedicare non covered items and services - part 2
NOT COVERED ITEMS AND SERVICE UNDER THE MEDICARE PROGRAM AND APPLICABLE EXCEPTIONS (2) Non-Covered Items and ServicesA) Custodial CareCustodial care furnished in the beneficiary’s home or an...
View ArticleRailroad Medicare Coverage of Supplies if You Have Diabetes
Railroad Medicare covers certain supplies if you have Medicare Part B and have diabetes. These supplies include:• Blood glucose self-testing equipment and supplies • Therapeutic shoes and inserts...
View ArticleMedicare non covered items and services - part 3
MEDICARE PROGRAM NON COVERED SERVICES3)Services and Supplies That Have Been Denied as Bundled or Included in the Basic Allowance of Another ServiceThe following services and supplies that have been...
View ArticleMedicare Overpayment Collection Process
If you are a Medicare Fee-For-Service provider who submits claims to Medicare Administrative Contractors, or MACs, you will benefit from this podcast! It will give you information to help you comply...
View ArticleGlobal Surgery Coding and Billing Guidelines - what modifier to use
Physicians Who Furnish the Entire Global Package Physicians who furnish the surgery and furnish all of the usual pre-and post-operative work may bill for the global package by entering the appropriate...
View ArticleSpecific Modifiers for Distinct Procedural Services
New coding requirements related to Healthcare Common Procedure Coding System (HCPCS) modifier -59 could impact your reimbursement.Change Request (CR) 8863 notifies MACs and providers that the Centers...
View ArticleNew or modified Remittance Advice Remark and Claims Adjustment Reason Code
New Codes – RARC Code Modified Narrative Effective DateN753 Missing/Incomplete/Invalid Attachment Control Number. 07/01/2015N754 Missing/Incomplete/Invalid Referring Provider or Other Source...
View ArticleSkilled Nursing Facility Coverage Requirements and Benefit Period
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...
View ArticleBilling and coverage for drug wastage
First Coast Service Options Inc. (First Coast) will consider payment for the unused and discarded portion of a single-use drug/biological product after administration of the appropriate (reasonable and...
View ArticleMedicare Program; Prior Authorization of Repetitive Scheduled Nonemergent...
This model will begin on December 1, 2014 in South Carolina, New Jersey, and Pennsylvania.Medicare covers ambulance services, including air ambulance (fixed wing and rotary wing) services, when...
View ArticleMedicare's Coverage of Chiropractic Services
Chiropractic services are becoming more popular as a way to correct spinal problems.Chiropractic services must be provided by doctors of chiropractic, also known as 'chiropractors' and 'chiropractic...
View Articlewhat is Pre-operative Period Billing and post operative billing ? Which...
Pre-operative Period BillingE /M Service Resulting in the Initial Decision to Perform Surgery Evaluation/ Management (E/M) services on the day before major surgery or on the day of major surgery that...
View Article