The AMA released a new CPT® code for use in non-facility settings for the expense related to supplies, equipment and staff time and activities for … [Read more...]
Coding Guide – How Physician Services are Paid
Table of Contents CPT® HCPCS Modifiers NCCI Multiple procedures Fee calculation Global surgical payment Diagnosis … [Read more...]
Medicare National Coverage Determination (NCD) for Ambulatory Blood Pressure Monitoring (ABPM): CPT® and ICD-10 Coding
CMS released an NCD for ABPM on July 2, 2019. CMS has expanded the coverage for ABPM by allowing it for a greater range of BP measurements. Of course, … [Read more...]
Physician specialty codes and claims processing
When physicians enroll in Medicare, they self-elect their specialty designation. In the enrollment process, there are fields to indicate primary and … [Read more...]
NGS changing processing of same day NP/PA claims
Is NGS your MAC? Did you see their announcement that for claims processed on or after Sept 15, 2018, they will no longer deny claims for a second … [Read more...]
Fee-for-service medicine | The rumors of my death have been greatly exaggerated!
Let me start with apologies for stealing Mark Twain’s words! And, a quick search will show I'm not the only one to apply these words to … [Read more...]
Two visits for the price of one? | Multiple medical visits on the same day
Patients often schedule two medical appointments on the same day with physicians of different specialties. It’s convenient for them. It saves travel … [Read more...]
Diagnosis Coding | Not just for claims anymore
Physician claims are paid based on the fee schedule associated with the CPT® or HCPCS code that is submitted. Diagnosis coding can be a reason for a … [Read more...]
Who is responsible for coding physician services? The medical provider or the coder?
Legally, when a physician, physician assistant (PA) or nurse practitioner (NP) enroll in a Medicare, Medicaid or commercial insurance, the … [Read more...]
OB Coder Survey | Billing extra visits during pregnancy
Thank you to the 63 generous coders and billers who answered my questions about billing extra OB visits during the maternity period. If we and our … [Read more...]
Skin Test for Tuberculosis (PPD)
How do we bill for placing the skin test for tuberculosis? To bill for placing the purified protein derivative (PPD) skin test for tuberculosis, use … [Read more...]
My payer doesn’t follow CPT® rules. What am I to do?
Why Are Medical Claims Denied? Most medical claim denials in practices aren’t related to coding. Medical claims are most frequently denied because … [Read more...]
Facility versus Non-Facility in the Physician Fee Schedule
CMS develops and publishes the Physician Fee Schedule in November of each year, as part of the Physician Fee Schedule Final Rule The fee schedule … [Read more...]
What is a Coverage Policy?
National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) are Medicare’s coverage policies that describe medical necessity for … [Read more...]
How Fees are Set in the Medicare Fee Schedule
How does Medicare set its fees? This is important, as well, because commercial payers often use the values set by Medicare to calculate their fees. … [Read more...]
How Physician Services are Paid – Infographic
CPT® Codes for Medical Reimbursement CPT® codes, HCPCS, modifiers, global surgical packages, CMS formulas, diagnosis codes, location, and more...how … [Read more...]
How Physician Services are Paid
Have a new staff member or practitioner who needs a primer on "how physician services are paid?" This short video is a must see! Learn how all the … [Read more...]