Chiropractic Local Coverage Determination and Supplemental Instructions Article May 1, _0214
|
|
|
- Claude Ferguson
- 8 years ago
- Views:
Transcription
1 Chiropractic Local Coverage Determination and Supplemental Instructions Article May 1, _0214
2 Today s Presenters Andrea Freibauer - Provider Outreach & Education Consultant Donna Pisani - Provider Outreach & Education Consultant 2 National Government Services, Inc.
3 Disclaimer National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract jurisdiction. National Government Services employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this material. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of publication, the Medicare Program is constantly changing, and it is the responsibility of each provider to remain abreast of the Medicare Program requirements. Any regulations, policies and/or guidelines cited in this publication are subject to change without further notice. Current Medicare regulations can be found on the Centers for Medicare & Medicaid Services (CMS) Web site at 3 National Government Services, Inc.
4 No Recording Attendees/providers are never permitted to record (tape record or any other method) our educational events This applies to our Webinars, teleconferences, live events, and any other type of National Government Services educational event 4 National Government Services, Inc.
5 Acronyms Please access the Acronyms page on the Web site to view any acronym used within this presentation. 5 National Government Services, Inc.
6 Objectives Provide a sampling of chiropractic billing concepts and guidelines to give you a better understanding of the Medicare Program, while helping to decrease your National Government Services claim submission billing errors. 6 National Government Services, Inc.
7 Agenda LCD Medical necessity Documentation guidelines Utilization guidelines Active vs. maintenance therapy SIA Significant facts for successful billing 7 National Government Services, Inc.
8 What Is a Chiropractic LCD
9 LCD L Coverage Document SIA A Supplemental Instructions LCD - Specific information need to bill Indications of Treatment Limitations of Treatment Primary/secondary ICD-9 codes supporting medical necessity Documentation requirements Utilization guidelines / frequency SIA - Coding guidelines 9 National Government Services, Inc.
10 10 National Government Services, Inc.
11 11 National Government Services, Inc.
12 Medical Necessity
13 Medicare Coverage Medical Necessity: Title XVIII of the Social Security Act, Section 1862 (a)(1)(a). This section allows coverage and payment for only those services considered medically reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member 13 National Government Services, Inc.
14 Medicare Coverage LCD-Medical Necessity The patient must have a significant health problem in the form of a neuro-musculoskeletal condition necessitating treatment and the manipulative services rendered must have a direct therapeutic relationship to the patient s condition and provide reasonable expectation of recovery or improvement of function. The patient must have a subluxation of the spine as demonstrated by x-ray or physical exam. 14 National Government Services, Inc.
15 Medical Necessity Medical Necessity Assures services to Medicare patients are reasonable and necessary for diagnosis or treatment of illness or injury Remittance Remark Code CO-50 Medical Necessity Denial 15 National Government Services, Inc.
16 Medical Necessity Denials Some services are only covered in some instances Example: Chiropractic manipulation ONLY covered for a diagnosis listed in LCD Any other diagnosis will be denied as not medically necessary 16 National Government Services, Inc.
17 Documentation Guidelines
18 Medical Necessity Documentation Written documentation (office records, diagnostic test results, etc.) Do not submit with claim Send to Medicare when requested Statement or diagnosis of just Pain not sufficient to support medical necessity 18 National Government Services, Inc.
19 Medical Necessity Documentation Precise level(s) of subluxation(s) must be specified for each spinal region manipulated List exact bones (C5,C6) Area/Region if it implies only certain bones Use terms that are clearly understood to refer to bone/joint space or position Document the need for an extensive/prolonged course of treatment Must be appropriate to the reported procedure code(s) 19 National Government Services, Inc.
20 Documentation of Subluxation X-ray 12 months before/three (3) months after CT/MRI Physical exam Asymmetry/misalignment ROM abnormality Soft tissue/tone changes Pain/tenderness Must have two (2) of the four (4) mentioned above, one of these must be asymmetry or ROM abnormality 20 National Government Services, Inc.
21 Documentation of Direct Relationship Mechanism of Injury Chief complaint Identify the subluxation 21 National Government Services, Inc.
22 Documentation Reasonable Expectation Age of the patient Comorbidities Prior level of function Measurable goals Keep it realistic Terms that relate to the patient s necessity for treatment 22 National Government Services, Inc.
23 Documentation of Initial Visit All components of history Evaluation Diagnosis Treatment plan Recommended level of care Signature 23 National Government Services, Inc.
24 Documentation of History Symptoms: What brought the patient in? Acute injury/trauma Chronic condition..why now? Prior level of function Health and relevant family history Patients age Comorbidities 24 National Government Services, Inc.
25 Documentation of History Previous occurrence? What worked, what failed? Detailed descriptors of symptoms Quality Onset Duration Intensity Character Location Radiation Frequency Other? 25 National Government Services, Inc.
26 Documentation of Subsequent Visits Link back to treatment plan-review Measure Progress towards goals Changes since last visit Exam Evaluate D/C when no further progress (or give an ABN) 26 National Government Services, Inc.
27 Documentation of a Treatment Plan Treatment plan Date of initiation of treatment History of prior treatment Means of measuring progress towards goals 27 National Government Services, Inc.
28 Documentation of a Treatment Plan Treatment plan Individualized Patient-centered Realistic Reasonable time-frame Tolerance 28 National Government Services, Inc.
29 Chiropractic LCD L27350
30 Medicare Coverage Break down of key points: Significant health problem in the form of a neuromusculoskeletal condition Services have a DIRECT therapeutic effect Reasonable expectation of recovery -ORimprovement of function Subluxation 30 National Government Services, Inc.
31 Covered Services CPT/HCPCS codes Chiropractic manipulative treatment CMT; spinal, one to two regions CMT; spinal, three to four regions CMT; spinal, five regions Regions: cervical, thoracic, lumbar, sacral, and pelvic 31 National Government Services, Inc.
32 Medicare Coverage Coverage is specifically limited to treatment by means of manual manipulation i.e., by use of hands Manual devices may be used but no additional payment is available for use of the device 32 National Government Services, Inc.
33 Utilization Guidelines A chiropractic manipulation service for a beneficiary can only be reimbursed once per day The frequency and duration of chiropractic treatment must be medically necessary and based on the individual patient s condition and response to treatment Medical necessity determines visits/no set number of visits 33 National Government Services, Inc.
34 Active vs. Maintenance Treatment
35 Active/Corrective Treatment Goal driven Treatment plan Individualized Usually short term Measurable progress towards goals 35 National Government Services, Inc.
36 Active Treatment Reasonable expectation of improvement Not always recovery Not always complete return to prior level of function 36 National Government Services, Inc.
37 Maintenance Preventative Promote health Prolong or enhance the quality of life Maintain/prevent deterioration 37 National Government Services, Inc.
38 Maintenance Supportive Noncorrective No reasonable expectation of further clinical improvement 38 National Government Services, Inc.
39 Maintenance May be beneficial May be necessary treatment Not covered by Medicare 39 National Government Services, Inc.
40 Noncovered Services The following services are considered noncovered services when ordered, performed, or interpreted by a chiropractor Labs Physical therapy (CPT 97140) X-rays Massage Use the GY modifier when billing these services 40 National Government Services, Inc.
41 Chiropractic SIA A47385
42 Coding Guidelines Two diagnosis required on all claims Precise level of the subluxation (region of spine) must be listed as the primary diagnosis Resulting disorders (condition) are to be listed as secondary diagnosis Date of initial treatment/exacerbation of existing condition Must be entered in Item 14 of the CMS-1500 claim form or the electronic equivalent 42 National Government Services, Inc.
43 Coding Guidelines If using an x-ray as documentation of the subluxation the date of the x-ray (or existing MRI or CT scan) must be entered in Item 19 of the CMS-1500 claim form or the electronic equivalent. HCPCS modifier AT (acute treatment) must be appended to chiropractic manipulation code to indicate manipulation was medically necessary and reasonable treatment of an acute subluxation/chronic subluxation as defined in national policy and the LCD 43 National Government Services, Inc.
44 Significant Facts for Successful Chiropractic Billing
45 Chiropractic Services Allowed Places of Service - SIA Office (11) Home (12) Assisted Living Facility (13) Group Home (14) Temporary Lodging (16) Inpatient Hospital (21) Outpatient Hospital (22) Emergency Room (23) Nursing Facility for Patients in Part A Stay (31) Nursing Facility for Patients not in Part A Stay (32) Custodial Care Facility (33) Independent Clinic (49) Comprehensive Outpatient Rehabilitation Facility (62) State or Local Public Health Clinic (71) 45 National Government Services, Inc.
46 Contacting the Telephone Reopening Unit TRU Line: follow prompt Part B TRU line hours of operation: Monday - Friday, 8:00 a.m.-3:00 p.m. ET Faxes are accepted and representatives are permitted to accept more than 3 claims per call When calling TRU, provide the following information: Beneficiary s name Medicare Health Insurance Claim Number Your full name (first and last name) Your phone number Provider s name Provider s number Date(s) of service in question Reason for request 46 National Government Services, Inc.
47 Record Requests/Documentation Tips Respond to an ADR within 30 days Documentation Legible Copy both sides Signatures Do not bind records together Do not highlight records Do not tab records Make sure the ADR request matches the records sent 47 National Government Services, Inc.
48 esmd-how to Submit Medical Records Electronically Submit ADR letter requests electronically Must either build a gateway or submit via Health Information Handler News Article: How to Submit Medical Records Electronically to National Government Services > Publications > News Articles 48 National Government Services, Inc.
49 Signature Requirements Signature requirements for medical documentation The use of stamped signatures is not acceptable on any medical record Medicare requires a legible identifier for services provided and ordered Medicare will accept handwritten, electronic signatures or facsimiles of original written or electronic signatures for medical review purposes The Medical Review department will deny claims not meeting the signature requirements on records requested on ADRs 49 National Government Services, Inc.
50 Timely Claims Filing Requirement Claims not submitted by time limit are provider-liable Beneficiary cannot be charged for provider-liable charges Claims submitted that include span dates of service, the line item From date will be used to determine the date of service and filing timeliness If a line item From date is not timely, but the To date is timely, the line item will be split and deny untimely services as not timely filed 50 National Government Services, Inc.
51 Submitting Duplicate Claims May delay payment Resubmitting your claim prior to receiving a determination not only increases administrative costs to the Medicare Program but to you as well Could cause you to be identified as an abusive biller; or may result in an investigation for fraud if a pattern of duplicate billing is identified Although National Government Services does not believe providers are trying to deliberately receive duplicate payment by submitting duplicate claims for one service we must remind providers that this is an inappropriate billing practice 51 National Government Services, Inc.
52 Jurisdiction K Part B PWK Fax and Mail Cover Sheet Form Is Now Available PWK Fax and Mail Cover Sheet Form PWK will allow documentation to be submitted with an electronic claim Use of PWK segment will allow providers to submit electronic claims that require additional documentation for claims adjudication This process allows voluntary submission of supporting documentation for a version 5010A1 electronic claim in one of two methods: By Mail - use BM if mailing the documentation By Fax - use FX if faxing the documentation 52 National Government Services, Inc.
53 Revalidation of Provider Enrollment Information SE Article SE1126 Provider Enrollment Revalidation - Wait until you hear from your MAC Need to Revalidate - If you enrolled in the Medicare Program prior to Friday, March 25, 2011 Do NOT submit your revalidation until you are notified to do so by your MAC. You will receive a notice to revalidate between now and March National Government Services, Inc.
54 Completing Online PECOS Enrollment Three basic steps Active NPPES User ID and Password/NPI Enumerator at Print, sign and date the Certification Statement and mail to the Medicare contractor along with all supporting paper documentation within 7 days of the electronic submission. Check status Processing time frames Internet-Based Process begins within 5 days of receipt - 90% within 45 days Non Internet-Based 80% within 60 days of receipt 54 National Government Services, Inc.
55 JK Contact Information IVR: Provider Contact Center: Fax on Demand: EDI Helpdesk: Correspondence National Government Services Part B Provider General Written Inquiries P.O. Box 6189 Indianapolis, IN Direct telephone number for Provider Enrollment (JK): Beginning Monday February 3, 2014, the provider enrollment number will be available 7:00 a.m.-6:00 p.m. ET. 55 National Government Services, Inc.
56 Fee Schedules 56 National Government Services, Inc.
57 Code Search Tool 57 National Government Services, Inc.
58 NGSCONNEX
59 What is NGSConnex? NGSConnex is a free Web application maintained by National Government Services NGSConnex allows for self-service functions including: Beneficiary eligibility Claim status Initiate reopening and/or redetermination request (Appeal) Obtain status of all redetermination requests View provider/supplier demographics Query financial data Submit cost reports, letters and supporting paperwork to Audit and Reimbursement (PART A ONLY) And more 59 National Government Services, Inc.
60 How to Sign Up for NGSConnex Sign up for NGSConnex by following the setup instructions at NGSConnex is FREE and only requires users to have an address and Internet access 60 National Government Services, Inc.
61 NGSConnex 61 National Government Services, Inc.
62 NGSConnex 62 National Government Services, Inc.
63 Comprehensive Error Rate Testing Recovery Audit Program
64 Who Performs CERT? Livanta CERT Documentation Contractor (CDC) Requests documentation for selected claims Advance Med-CERT Review Contractor (CRC) Reviews Notify the fiscal intermediary for adjustments 64 National Government Services, Inc.
65 65 National Government Services, Inc.
66 66 National Government Services, Inc.
67 67 National Government Services, Inc.
68 Who Performs Recovery Audits? Region A: Performant Recovery, Inc. Contact Information: Web site: Telephone: National Government Services, Inc.
69 69 National Government Services, Inc.
70 RA Issues Under Review 70 National Government Services, Inc.
71 Coverage and Billing Resources CMS IOM Publication , Medicare Benefit Policy Manual, Chapter 15 Section 30.5, Physician Services-Chiropractic Services Section 240, Chiropractic Services-General National Government Services - Chiropractic Services LCD: L27350 SIA: A National Government Services, Inc.
72 72 National Government Services, Inc.
73 Updates Subscribe to receive the latest, up-to-date Medicare information. 73 National Government Services, Inc.
74 Web Site Survey This is your chance to have your voice heard Say yes when you see this pop-up so National Government Services can make your job easier! 74 National Government Services, Inc.
75 Medicare University Interactive online system available 24/7 Educational opportunities available Computer-based training courses Teleconferences, Webinars, live seminars/face-toface training Self-report attendance 75 National Government Services, Inc.
76 Medicare University Self-Reporting Instructions Log on to the National Government Services Medicare University site at Topic = JK: Chiropractic Local Coverage Determination and Supplemental Instructions Article Medicare University Credits (MUCs) = 1 Catalog Number = To be provided Course Code = To be provided For step-by-step instructions on self-reporting please visit > Medicare University > Accessing the Self-Reporting Tool 76 National Government Services, Inc.
77 Thank You! Andrea & Donna 77 National Government Services, Inc.
JK: Provider Enrollment 855I and 855R 1532_0214
JK: Provider Enrollment 855I and 855R 1532_0214 Presenters Carleen Parker Provider Outreach & Education Donna Pisani Provider Outreach & Education 2 National Government Services, Inc. Disclaimer National
Medicare Part B Updates
Medicare Part B Updates AAHAM January 23, 2015 Add doc ctrl no. Today s Presenter Gail O Leary Provider Outreach & Education Representative 2 1 Disclaimer National Government Services, Inc. has produced
Chiropractor Compliance Summary Documentation Compliance Criteria for Chiropractic Claims Submitted to the Funds
Chiropractor Compliance Summary Documentation Compliance Criteria for Chiropractic Claims Submitted to the Funds Date: April 23, 2012 Source Information: Medicare Policy Purpose The United Mine Workers
Understanding Additional Development Requests (ADRs) and How to Respond to Them
Understanding Additional Development Requests (ADRs) and How to Respond to Them May 1, 2014 Today s Presenter Corrinne Ball, RN, CPC, CAC Provider Outreach and Education Consultant 2 Disclaimer National
Medicare Diagnosis By Dr. Ron Short, DC, MCS-P
Medicare Diagnosis By Dr. Ron Short, DC, MCS-P Diagnosis o The diagnosis is one of two codes that you place on the CMS 1500 form when you submit a claim. o The diagnosis communicates the patient s condition
Partial Hospitalization Program Interim Billing Guidelines
Partial Hospitalization Program Interim Billing Guidelines March 2013 1449_0313 Today s Presenters Christine Janiszcak, Provider Outreach & Education Consultant Pat Zachmann, Provider Outreach & Education
Mississippi Medicaid. Provider Reference Guide. For Part 203. Physician Services
Mississippi Medicaid Provider Reference Guide For Part 203 Physician Services This is a companion document to the Mississippi Administrative Code Title 23 and must be utilized as a reference only. January
Home Health & Hospice Interactive Voice Response (IVR) System User Guide
Home Health & Hospice Interactive Voice Response (IVR) System July 2014 2014 Copyright, CGS Administrators, LLC Table of Contents Introduction... 3 Required Information... 3 Menu Options... 4 Claim Status
Handbook for Home Health Agencies
Handbook for Home Health Agencies Chapter R-200 Policy and Procedures For Home Health Agencies Illinois Department of Public Aid CHAPTER R-200 Home Health Agency Services TABLE OF CONTENTS FOREWORD R-200
ALLEVIATE WELLNESS CENTER RECEIVED UNALLOWABLE MEDICARE PAYMENTS FOR CHIROPRACTIC SERVICES
Department of Health and Human Services OFFICE OF INSPECTOR GENERAL ALLEVIATE WELLNESS CENTER RECEIVED UNALLOWABLE MEDICARE PAYMENTS FOR CHIROPRACTIC SERVICES Inquiries about this report may be addressed
Home Health Billing Scenarios - DRAFT. Disclaimer
Home Health Billing Scenarios - DRAFT 1493_1013 Disclaimer National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract
Section 9. Claims Claim Submission Molina Healthcare PO Box 22815 Long Beach, CA 90801
Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your
American Chiropractic Association. Commentary on Centers for Medicare and Medicaid Services (CMS)/PART. Clinical Documentation Guidelines
American Chiropractic Association Commentary on Centers for Medicare and Medicaid Services (CMS)/PART Clinical Documentation Guidelines DISCLAIMER The American Chiropractic Association provides this commentary
Note: This article was updated on January 3, 2013, to reflect current Web addresses. All other information remains unchanged.
News Flash The Centers for Medicare & Medicaid Services (CMS) is listening and wants to hear from you about the services provided by your Medicare Fee-for-Service (FFS) contractor that processes and pays
Handbook for Providers of Therapy Services
Handbook for Providers of Therapy Services Chapter J-200 Policy and Procedures For Therapy Services Illinois Department of Healthcare and Family Services CHAPTER J-200 THERAPY SERVICES TABLE OF CONTENTS
Payment Policy. Evaluation and Management
Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions
How To Get A Medicare Checkup
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Chiropractic Services ICN 906143 October 2013 This booklet was current at the time it was published or uploaded onto the
External Breast Prosthesis. 2012 Copyright, CGS Administrators, LLC.
External Breast Prosthesis 1 Agenda Coverage Criteria Modifier Use Documentation Cert Findings Cert Requirements Jurisdiction C Resources 2 Coverage 3 Coverage Criteria A breast prosthesis can be made
Page 1 of 11. MLN Matters Number: SE1010 REVISED Related Change Request (CR) #: 6740. Related CR Release Date: N/A Effective Date: January 1, 2010
News Flash Version 3.0 of the Measures Groups Specifications Manual released in November 2009 for 2010 PQRI has been revised. Version 3.1 of the 2010 PQRI Measures Groups Specifications Manual and Release
Palmetto GBA and the Jurisdiction 11 World
Palmetto GBA and the Jurisdiction 11 World 1 Disclaimer This presentation was current at the time it was published or uploaded onto the Palmetto GBA Web site. Medicare policy changes frequently so links
Claims Procedures. H.2 At a Glance. H.4 Submission Guidelines. H.9 Claims Documentation. H.17 Codes and Modifiers. H.
H.2 At a Glance H.4 Submission Guidelines H.9 Claims Documentation H.17 Codes and Modifiers H.22 Reimbursement H.25 Denials and Appeals At a Glance pledges to provide accurate and efficient claims processing.
CHAPTER 7 (E) DENTAL PROGRAM CLAIMS FILING CHAPTER CONTENTS
CHAPTER 7 (E) DENTAL PROGRAM CHAPTER CONTENTS 7.0 CLAIMS SUBMISSION AND PROCESSING...1 7.1 ELECTRONIC MEDIA CLAIMS (EMC) FILING...1 7.2 CLAIMS DOCUMENTATION...2 7.3 THIRD PARTY LIABILITY (TPL)...2 7.4
KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. Ambulance
KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL Ambulance PART II Introduction Section BILLING INSTRUCTIONS Page 7000 Ambulance Billing Instructions............... 7-1 Submission of Claim..................
Local Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852)
Local Coverage Article: Venipuncture Necessitating Physician s Skill for Specimen Collection Supplemental Instructions Article (A50852) Contractor Information Contractor Name CGS Administrators, LLC Article
Oxygen. 1554_0714_oxygen.pptx. Billing, Common Audit Errors and Tips to Avoid Them
Oxygen 1554_0714_oxygen.pptx Billing, Common Audit Errors and Tips to Avoid Them Today s Presenters Charity Bright Provider Outreach and Education Consultant Stacie McMichel Provider Outreach and Education
Medicare Part B - Current Updates October 2015
Medicare Part B - Current Updates October 2015 Disclaimer Every reasonable effort has been made to ensure the accuracy of this information. However, the provider has the ultimate responsibility for compliance
Federally Qualified Health Center Billing and Coverage
Federally Qualified Health Center Billing and Coverage May 1, 2014 Today s Presenter Mimi Vier, CPC Provider Outreach and Education Consultant 2 Disclaimer National Government Services, Inc. has produced
CLAIMS Section 5. Overview. Clean Claim. Prompt Payment. Timely Claims Submission. Claim Submission Format
Overview The Claims department partners with the Provider Relations, Health Services and Customer Service departments to assist providers with any claims-related questions. The focus of the Claims department
HOSPITAL-ISSUED NOTICE OF NONCOVERAGE
HOSPITAL-ISSUED NOTICE OF NONCOVERAGE Citations and Authority for Hospital-Issued Notice of Noncoverage (HINNs) The statutory authorities applicable to your review of a Hospital-Issued Notice of Noncoverage
Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols
Surgical/ASC Claims Revenue Cycle Management: An Introduction to Our Processes and Protocols 200 Old Country Road, Suite 470 Mineola, NY 11501 Phone: 516-294-4118 Fax: 516-294-9268 www.businessdynamicslimited.com
Molina Healthcare of Puerto Rico (MHPR) Non-Participating Provider Information
Molina Healthcare of Puerto Rico (MHPR) Non-Participating Provider Information Please refer to Carta Normativa 15-0326 Re Transicion for details regarding the ASES-established Transition of Care and Reimbursement
Qtr 2. 2011 Provider Update Bulletin
West Virginia Medicaid WEST VIRGINIA Department of Health & Human Resources Qtr 2. 2011 Provider Update Bulletin West Virginia Medicaid Provider Update Bulletin Qtr. 2, 2011 Volume 1 Inside This Issue:
National Government Services Connex Quick Steps
National Government Services Connex Quick Steps Table of Contents Table of Contents... 1 Detailed Setup Instructions... 3 Detailed setup instructions for new Connex users are available by going to http://www.ngsmedicare.com
Molina Healthcare of Ohio, Inc. PO Box 22712 Long Beach, CA 90801
Section 9. Claims As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your
Proper & Ethical Billing & Coding CE Exam 4 Hours ~ Back To Chiropractic CE Seminars
Proper & Ethical Billing & Coding CE Exam 4 Hours ~ Back To Chiropractic CE Seminars Simply list your answers (write down letter choice only: (for True use letter a ) (for FALSE use letter b ) in a NUMBERED
Medical Necessity and Coding
Medical Necessity and Coding NEW MEXICO HEALTH INFORMATION MANAGEMENT ASSOCIATION FALL CODING WORKSHOP September 14, 2012 Hyatt Downtown Albuquerque, NM Presented by: Andrea Busby, RHIA ADHIMA, INC Goals
Basic Medical Record Documentation
Basic Medical Record Documentation Presented by Cahaba Government Benefit Administrators, LLC P rovider O u t reach and Education September 19, 2013 1 Disclaimers This resource is not a legal document.
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Medicare is denying an increasing number of claims, because providers are not identifying the correct primary payer prior
Basics of Skilled Nursing Facility Consolidated Billing (SNF-CB) Medicare Part A and B Presentation March 19, 2013
Basics of Skilled Nursing Facility Consolidated Billing (SNF-CB) Medicare Part A and B Presentation March 19, 2013 2 Agenda Skilled Care Defined Background on SNF-CB Under Arrangements Inclusions and Exclusions
A. CPT Coding System B. CPT Categories, Subcategories, and Headings
OST 148 MEDICAL CODING, BILLING AND INSURANCE COURSE DESCRIPTION: Prerequisites: None Corequisites: None This course introduces CPT and ICD coding as they apply to medical insurance and billing. Emphasis
WEEK CHAPTER OBJECTIVES ASSIGNMENTS & TESTS 19-20 6A medical necessity as it ICD-9-CM Coding. relates to reporting diagnosis codes on claims.
HEALTH INSURANCE & CODING Textbook: Understanding Health Insurance: A Guide to Billing and Reimbursement 11 th edition Website Activities: StudyWARE Online Practice Software linked to the book. SimClam:
Getting Started With. Internet-based Provider Enrollment, Chain and Ownership System (PECOS) Information for Provider and Supplier Organizations
Getting Started With Internet-based Provider Enrollment, Chain and Ownership System (PECOS) Information for Provider and Supplier Organizations June 1, 2009 The Centers for Medicare & Medicaid Services
MANAGING MEDICARE IN 2014: Fighting Back-Managing Claims. California Orthopaedic Association May 30, 2014
MANAGING MEDICARE IN 2014: Fighting Back-Managing Claims California Orthopaedic Association May 30, 2014 Healthcare System Changing Current orthopedic practices are evolving Only thing constant is change
Frequently Asked Billing Questions
Frequently Asked Billing Questions How will I be billed? Mayo Clinic Health System will send you a billing statement with your charges. Provider charges for clinic and hospital services will be billed
Hospice Widespread edits
Hospice Widespread edits Befriend this foe to prevent claim denials Beth Noyce, RN, BSJMC, HCS-D D, COS-C C Clinical Educator & QA Specialist and Dana Walling, RN, COS-C Director of Nursing, Branch Manager
Section 6. Medical Management Program
Section 6. Medical Management Program Introduction Molina Healthcare maintains a medical management program to ensure patient safety as well as detect and prevent fraud, waste and abuse in its programs.
10/9/2015. J6: Illinois State Ambulance Association. Today s Presenter. Disclaimer. J6 Provider Outreach and Education Consultant
J6: Illinois State Ambulance Association October 2015 Add doc ctrl no. Today s Presenter J6 Provider Outreach and Education Consultant Carolyn S Henson CPC,CAC,CACO,CPC-I AAPC I-10 Instructor 2 Disclaimer
KANSAS MEDICAL ASSISTANCE PROGRAM. Provider Manual. Psychiatric Residential Treatment Facility
Provider Manual Psychiatric Residential Treatment Facility Updated 11/2011 PART II Introduction Section 7000 7010 7020 8100 8300 8400 BILLING INSTRUCTIONS Introduction to the CMS-1500 Claim Form......
(EHR) Incentive Program
REGISTRATION USER GUIDE For Eligible Professionals Medicaid Electronic Health Record (EHR) Incentive Program DECEMBER 2010 (01.20.11 ver3) CONTENTS Step 1... Getting started 3 Step 2... Login instruction
Critical Access Hospital (CAH) and CAH Swingbed Questions and Answers
Critical Access Hospital (CAH) and CAH Swingbed Questions and Answers The following questions and answers are from the April 2012 CAH and CAH Swingbed web-based trainings: Q1. Is a non-covered/no pay bill
Tennessee Ambulance Services Association Conference
Tennessee Ambulance Services Association Conference Nashville, TN October 7, 2014 Clinical Education Presented by Julia McKinley, RN, MAED Provider Outreach and Education Disclaimers This resource is not
National Correct Coding Initiative Policy Manual for Medicare Services Revision Date: January 1, 2014
National Correct Coding Initiative Policy Manual for Medicare Services Revision Date: January 1, 2014 Current Procedural Terminology 2013 American Medical Association. All Rights Reserved. Current Procedural
How To Participate In The Well Sense Health Plan
Well Sense Health Plan How We Do Business with Providers New Hampshire Health Protection Program August 2014 Agenda Working with Well Sense and our members Our partners Provider responsibilities Resources
The Guide to Medicare Preventive Services for Physicians, Providers, Suppliers, and Other Health Care Professionals. May 2005
for Physicians, Providers, Suppliers, and Other Health Care Professionals May 2005 DISCLAIMER This Guide was prepared as a tool to assist providers and is not intended to grant rights or impose obligations.
Federally Qualified Health Center Billing (100)
1. As a federally qualified health center (FQHC) can we bill for a license medical social worker? The core practitioner must be a licensed or certified clinical social worker (CSW) in your state. Unless
Medicare Enrollment Guide for Individual Physicians
Medicare enrollment processes have changed considerably over the years, and even more so with the introduction of national provider identifiers (NPIs). The enrollment application process for individuals
Local Coverage Determination (LCD): Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705)
Local Coverage Determination (LCD): Spinal Cord Stimulation (Dorsal Column Stimulation) (L34705) Contractor Information Contractor Name Novitas Solutions, Inc. LCD Information Document Information LCD
Premera Blue Cross Medicare Advantage Provider Reference Manual
Premera Blue Cross Medicare Advantage Provider Reference Manual Introduction to Premera Blue Cross Medicare Advantage Plans Premera Blue Cross offers Medicare Advantage (MA) plans in King, Pierce, Snohomish,
2010 BCBSNC Provider Conference Top 20 Questions Answers
Questions Answers There is currently no centralized listing of all out-of-state Blue Plan alpha prefixes. There is a listing available for BCBSNC alpha prefixes only; please contact your Provider Relations
Federally Qualified Health Centers (FQHC) Billing 1163_0212
Federally Qualified Health Centers (FQHC) Billing 1163_0212 Today s Presenter Charles Wiley- Provider Outreach and Education Representative 2 Disclaimer has produced this material as an informational reference
Compensation and Claims Processing
Compensation and Claims Processing Compensation The network rate for eligible outpatient visits is reimbursed to you at the lesser of (1) your customary charge, less any applicable co-payments, coinsurance
Glossary of Insurance and Medical Billing Terms
A Accept Assignment Provider has agreed to accept the insurance company allowed amount as full payment for the covered services. Adjudication The final determination of the issues involving settlement
Blue Care Network Physical & Occupational Therapy Utilization Management Guide Published 11/13/2012
Blue Care Network Physical & Occupational Therapy Utilization Management Guide Published 11/13/2012 Landmark Healthcare, Inc., oversees outpatient physical, occupational and speech services for BCN members
INTRODUCTION. The Workers Compensation Act provides in part as follows:
INTRODUCTION The Maryland Workers Compensation Commission (Commission) amended COMAR 14.09.03.01 (Guide of Medical and Surgical Fees) on February 12, 2004. AUTHORITY The Workers Compensation Act provides
A/B MAC Jurisdiction E Implementation Overview
A/B MAC Jurisdiction E Implementation Overview 2013 Agenda Welcome and Introduction JE Implementation Timeline What Remains the Same Electronic Funds Transfer (EFT) Interactive Voice Response (IVR) Functionality
ATTENTION PRACTICE MANAGERS
Volume VI; June 2013 ATTENTION PRACTICE MANAGERS MUST USE Easier to Read Asterisks detailing required information New telephonic team working to give you timely status updates AZPCP Prior Authorization
Ask Cahaba A Teleconference June 9, 2015
Ask Cahaba A Teleconference June 9, 2015 Cahaba Attendees Yolanda Maye Karen McGrath Renea Cloud Christie Dunagan John Florence Cahaba hosted the quarterly Ask the Contractor Teleconference on Tuesday,
Medicare Secondary Payer Fact Sheet. for Provider, Physician, and Other Supplier Billing Staff
Secondary Payer Fact Sheet for Provider, Physician, and Other Supplier Billing Staff BacM kground aintaining the viability and integrity of the Trust Fund becomes critical as the Program matures and the
Medicare Enrollment Guide for Individual Physicians
Medicare enrollment processes have changed considerably over the years, and even more so with the introduction of national provider identifiers (NPIs). The enrollment application process for individuals
Connecticut Medical Assistance Program Refresher for Home Health Providers. Presented by The Department of Social Services & HP for Billing Providers
Connecticut Medical Assistance Program Refresher for Home Health Providers Presented by The Department of Social Services & HP for Billing Providers 1 Training Topics Home Health Agenda Fee Schedule Update
COM Compliance Policy No. 3
COM Compliance Policy No. 3 THE UNIVERSITY OF ILLINOIS AT CHICAGO NO.: 3 UIC College of Medicine DATE: 8/5/10 Chicago, Illinois PAGE: 1of 7 UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE CODING AND DOCUMENTATION
PROVIDER MANUAL Rehabilitative Therapy Services
KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL Rehabilitative Therapy Services Physical Therapy Occupational Therapy Speech/Language Pathology PART II REHABILITATIVE THERAPY PROVIDER MANUAL Introduction
Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc.
Shellie Sulzberger, LPN, CPC, ICDCT-CM Coding & Compliance Initiatives, Inc. Reasonable efforts have been made to provide the most accurate and current information on CPT 2015 code changes. However codes,
How To Contact Americigroup
Mental Health Rehabilitative Services and Mental Health Targeted Case Management TXPEC-0870-14 1 Agenda Key contacts Eligibility Mental Health Rehabilitative services (MHR) and Mental Health Targeted (TCM)
Inquiries, Reopenings, & Appeals Chapter 13
Chapter 13 Contents 1. Telephone Inquiries 2. Written Inquiries 3. mycgs The Jurisdiction C Web Portal 4. Provider Outreach and Education (POE) Department 5. Reopenings for Minor Errors and Omissions 6.
Therapies Physical, Occupational, Speech
Therapies Physical, Occupational, Speech Provider Manual Volume II April 1, 2013 New Hampshire Medicaid Table of Contents 1. NH MEDICAID PROVIDER BILLING MANUALS OVERVIEW... 1 Intended Audience... 1 Provider
Zimmer Payer Coverage Approval Process Guide
Zimmer Payer Coverage Approval Process Guide Market Access You ve Got Questions. We ve Got Answers. INSURANCE VERIFICATION PROCESS ELIGIBILITY AND BENEFITS VERIFICATION Understanding and verifying a patient
AMERICAN OSTEOPATHIC ASSOCIATION
AMERICAN OSTEOPATHIC ASSOCIATION October 10, 2012 Department of Practice Management and Delivery Innovations Presents: Audits and Denied Claims Billing & Coding for OMM: Addressing Practice Audits and
Disclaimers. Responsibility for correct claims submission lies with the provider of services.
CMS Signature Requirements Hand Written or Electronic Presented by Cahaba Government Benefit Administrators, LLC Provider Outreach and Education March 28, 2013 Disclaimers This resource is not a legal
(EHR) Incentive Program
REGISTRATION USER GUIDE For Eligible Professionals Medicaid Electronic Health Record (EHR) Incentive Program JANUARY 2012 (01.01.12 ver4) CONTENTS Step 1... Getting started 3 Step 2... Login instruction
New York. UnitedHealthcare Community Plan Claims System Migration Provider Quick Reference Guide. Complete Claims. Our Claims Process
Our Claims Process Here are a few steps to ensure you receive prompt payment: 1 Review and copy both sides of the member s ID card. members receive an ID card containing information that helps you process
Medicare Part B Customer Service Representative (CSR) Line & Interactive Voice Recognition (IVR) System 1-855-609-9960 Jurisdiction E
Medicare Part B Customer Service Representative (CSR) Line & Interactive Voice Recognition (IVR) System 1-855-609-9960 Jurisdiction E Hours of Availability CSR Monday-Friday: 6 a.m. to 5 p.m. PT. IVR Monday-Friday:
SECTION 4. A. Balance Billing Policies. B. Claim Form
SECTION 4 Participating Physicians, hospitals and ancillary providers shall be entitled to payment for covered services that are provided to a DMC Care member. Payment is made at the established and prevailing
The Official Guidelines for coding and reporting using ICD-9-CM
Reporting Accurate Codes In the Era of Recovery Audit Contractor Reviews Sue Roehl, RHIT, CCS The Official Guidelines for coding and reporting using ICD-9-CM A set of rules that have been developed to
Chapter 8 Billing on the CMS 1500 Claim Form
8 Billing on the CMS 1500 Claim form INTRODUCTION The CMS 1500 claim form is used to bill for non-facility services, including professional services, freestanding surgery centers, transportation, durable
Supplemental Medical Plan Your Kaiser Foundation Health Plan (KFHP) or Kaiser Employee Medical Health Plan (KEMHP) provides
Supplemental Medical Plan Your Kaiser Foundation Health Plan (KFHP) or Kaiser Employee Medical Health Plan (KEMHP) provides basic medical coverage. The Supplemental Medical Plan covers certain medical
NIA Magellan 1 Hip, Knee & Spine Surgery Frequently Asked Questions (FAQs) for Florida Blue Medicare Advantage BlueMedicare SM HMO and PPO Plans
NIA Magellan 1 Hip, Knee & Spine Surgery Frequently Asked Questions (FAQs) for Florida Blue Medicare Advantage BlueMedicare SM HMO and PPO Plans Question GENERAL Why is Florida Blue implementing a Musculoskeletal
2015 Novitas Solutions Medicare Symposiums
2015 Novitas Solutions Medicare Symposiums Novitas Solutions, the Medicare Administrative Contractor for Jurisdiction L and Jurisdiction H invites you to join our signature educational event: 2015 Medicare
Molina Healthcare of Washington, Inc. CLAIMS
CLAIMS As a contracted provider, it is important to understand how the claims process works to avoid delays in processing your claims. The following items are covered in this section for your reference:
Frequently Asked Questions About Your Hospital Bills
Frequently Asked Questions About Your Hospital Bills The Registration Process Why do I have to verify my address each time? Though address and telephone numbers remain constant for approximately 70% of
CLAIMS AND BILLING INSTRUCTIONAL MANUAL
CLAIMS AND BILLING INSTRUCTIONAL MANUAL 2007 TABLE OF ONTENTS Paper Claims and Block Grant Submission Requirements... 3 State Requirements for Claims Turnaround Time... 12 Claims Appeal Process... 13 Third
Recovery Audit Contractors (RACs) and Medicare The Who, What, When, Where, Why and How?
Recovery Audit Contractors (RACs) and Medicare The Who, What, When, Where, Why and How? Eileen Turner Acting Associate Regional Administrator Centers for Medicare & Medicaid Services San Francisco Regional
(EHR) Incentive Program
ATTESTATION USER GUIDE For Eligible Professionals Medicare Electronic Health Record (EHR) Incentive Program APRIL 2011 (04.12.11 ver1) CONTENTS Step 1... Getting started 4 Step 2... Login instruction 5
JULY2013 (07.09.13 ver9)
JULY2013 (07.09.13 ver9) CONTENTS Step 1... Getting started 3 Step 2... Login 5 Step 3... Welcome 12 Step 4... Registration instructions 13 Step 5... Reason for this registration 14 Step 6... Incentive
ATTENTION: ALTERNATIVE BILLING CONCEPTS (ABC) CODES FOR BEHAVIORAL HEALTH SERVICES TO END AS OF 12/31/2009
ATTENTION: ALTERNATIVE BILLING CONCEPTS (ABC) CODES FOR BEHAVIORAL HEALTH SERVICES TO END AS OF 12/31/2009 Alaska Medical Assistance will transition from use of Alternative Billing Concepts (ABC) procedure
How To Get Reimbursed For A Car Accident
PRAETORIAN INSURANCE COMPANY PERSONAL INJURY PROTECTION IMPORTANT NOTICE TO POLICYHOLDERS MEDICAL PROTOCOLS DECISION POINT REVIEW: Pursuant to N.J.A.C. 11:3-4, the New Jersey Department of Banking and
Medicare Coding and Billing Part 2 Sequestration Revalidation Comparative Billing Reports Importance of PQRS CMS 1500 Form Item 14 -
Medicare Coding and Billing Part 2 Sequestration As of now there are no changes in Sequestration. The Medicare Fee Schedule will change April 1. If you are a non-par doctor, check your MAC website for
MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT
DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT FORM APPROVED OMB NO. 0938-0373 Name(s) and Address of Participant*
Medicare Coding and Billing Part 1
Medicare Coding and Billing Part 1 Medicare Fee ScheduleMedicare has released next year s fee schedule There is a 27% cut in fees. This will be in effect until Congress takes action to delay it again.
Consumer Toolkit for Navigating Behavioral Health and Substance Abuse Care Through Your Health Insurance Plan
ConneCtiCut insurance DePARtMent Consumer Toolkit for Navigating Behavioral Health and Substance Abuse Care Through Your Health Insurance Plan What consumers need to know about seeking approval for behavioral