New Medicare Policy May Adversely Affect Medi-Cal Dialysis Providers
|
|
|
- Annabelle Sutton
- 10 years ago
- Views:
Transcription
1 Chronic Dialysis Clinics Medi-Cal Bulletin March 2007 New Medicare Policy May Adversely Affect Medi-Cal Dialysis Providers Effective April 1, 2007, Medicare contractors will require End Stage Renal Dialysis (ESRD) facilities to bill their monthly services separately by service date. This may result in claims that exceed Medi-Cal s claim line limitation for automatic electronic crossover claims. Automatic crossover claims from Medicare to Medi-Cal that exceed 15 detail lines will be rejected. Providers must then resubmit the claims according to the instructions in the Medicare/Medi-Cal Crossover Claims: Outpatient Services manual section, under Split Billing: More Than 15 Line Items for Part B Services Billed to Part A Intermediaries on pages 15 and 16. Claim examples are included in this Updated Information Bulletin. These examples are based on the new UB-04 claim form that will be available for use by providers on April 23. These examples will be included in manual replacement pages distributed to providers as part of a special May 2007 bulletin. Note: Supplies and Epoetin are not subject to the Medicare line item billing requirements. The Centers for Medicare & Medicaid Services (CMS) is implementing this change to comply with the Health Insurance Portability and Accountability Act (HIPAA) requirements for outpatient billing while limiting Medicare denials of legitimate services falling within overlapping service dates caused by the previous billing method. CMS is aware that Medi-Cal and other State Medicaid Agencies are affected by this change. The California Department of Health Services (CDHS) is working on a plan to mitigate the adverse impact of this change. Providers should refer to future Medi-Cal Updates for more information about this issue. Please see Medicare Policy, page 2
2 Figure a. Billing for Medi-Cal for Part B Dialysis Services for More Than 15 Lines. Split Bill Claim 1 of 2 (see also Figure c). Please see Medicare Policy, page 3 2
3 Figure b (continued from Figure a). Billing Medi-Cal for Part B Dialysis Services for More Than 15 Lines. Split Bill Claim 2 of 2 (see also Figure d). Please see Medicare Policy, page 4 3
4 Medicare National Standard Intermediary Remittance Advice A1 Dialysis FPE: 11/30/07 Part A Medicare Contractor 100 First Street PAID: 12/15/ th Street Anytown, CA CLM#: 166 City CA TOB: PATIENT: DOE, JANE PCN: HIC: X SVC FROM: 11/02/2007 MRN: PAT STAT: CLAIM STAT: 1 THRU: 11/30/2007 ICN: CHARGES: PAYMENT DATA: =DRG =REIM RATE =REPORTED 0.00 =DRG AMOUNT 0.00 =MSP PRIM PAYER 0.00 =NCVD/DENIED 0.00 =DRG/OPER/CAP 0.00 =PROF COMPONENT 0.00 =CLAIM ADJS 0.00 =LINE ADJ AMT 0.00 =ESRD AMOUNT =COVERED 0.00 =OUTLIER (C) 0.00 =PROC CD AMOUNT DAYS/VISITS: 0.00 =CAP OUTLIER =ALLOW/REIM 0 =COST REPT 0.00 =CASH DEDUCT 0.00 =G/R AMOUNT 0 =COVD/UTIL 0.00 =BLOOD DEDUCT 0.00 =INTEREST 0 =NON-COVERED =COINSURANCE 0.00 =CONTRACT ADJ 0 =COVD VISITS 0.00 =PAT REFUND 0.00 =PER DIEM AMT 0 =NCOV VISITS 0.00 =MSP LIAB MET =NET REIM AMT REV DATE HCPCS APC/HIPPS MODS QTY CHARGES ALLOW/REIM GC RSN AMOUNT REMARK CODES /02 A PR /02 Q PR /05 J PR /12 J PR /19 J PR /26 J PR /05 J PR /12 J PR /19 J PR /26 J PR / PR /02 G PR / G PR / PR / PR Claim 1 of / PR / PR / PR / PR / PR / PR / PR / PR / PR / PR Figure c. Medicare National Standard Intermediary Remittance Advice Example Split Bill Claim 1 of 2. Note: Supplies and Epoetin are not subject to Medicare s line item billing requirement. Please see Medicare Policy, page 5 4
5 Medicare National Standard Intermediary Remittance Advice A1 Dialysis FPE: 11/30/07 Part A Medicare Contractor 100 First Street PAID: 12/15/ th Street Anytown, CA CLM#: 166 City CA TOB: PATIENT: DOE, JANE PCN: HIC: X SVC FROM: 11/02/2007 MRN: PAT STAT: CLAIM STAT: 1 THRU: 11/30/2007 ICN: CHARGES: PAYMENT DATA: =DRG =REIM RATE =REPORTED 0.00 =DRG AMOUNT 0.00 =MSP PRIM PAYER 0.00 =NCVD/DENIED 0.00 =DRG/OPER/CAP 0.00 =PROF COMPONENT 0.00 =CLAIM ADJS 0.00 =LINE ADJ AMT 0.00 =ESRD AMOUNT =COVERED 0.00 =OUTLIER (C) 0.00 =PROC CD AMOUNT DAYS/VISITS: 0.00 =CAP OUTLIER =ALLOW/REIM 0 =COST REPT 0.00 =CASH DEDUCT 0.00 =G/R AMOUNT 0 =COVD/UTIL 0.00 =BLOOD DEDUCT 0.00 =INTEREST 0 =NON-COVERED =COINSURANCE 0.00 =CONTRACT ADJ 0 =COVD VISITS 0.00 =PAT REFUND 0.00 =PER DIEM AMT 0 =NCOV VISITS 0.00 =MSP LIAB MET =NET REIM AMT REV DATE HCPCS APC/HIPPS MODS QTY CHARGES ALLOW/REIM GC RSN AMOUNT REMARK CODES /02 A PR /02 Q PR /05 J PR /12 J PR /19 J PR /26 J PR /05 J PR /12 J PR /19 J PR /26 J PR / PR /02 G PR / G PR / PR / PR / PR / PR / PR Claim / PR / PR of / PR / PR / PR / PR / PR Figure d. Medicare National Standard Intermediary Remittance Advice Example Split Bill Claim 2 of 2. Note: Supplies and Epoetin are not subject to Medicare s line item billing requirement. 5
To submit electronic claims, use the HIPAA 837 Institutional transaction
3.1 Claim Billing 3.1.1 Which Claim Form to Use Claims that do not require attachments may be billed electronically using Provider Electronic Solutions (PES) software (provided by Electronic Data Systems
Accounts Receivable (A/R) Management The objective of this chapter is to provide an overview of
69 Section One: Section Title Chapter 6 Accounts Receivable (A/R) Management The objective of this chapter is to provide an overview of patient account transactions and accounts receivable management.
MEDICARE CREDIT BALANCE REPORT CERTIFICATION PAGE
DEPAR ARTMENT OF HEALTH AND HUMAN SERVICES Form Approved OMB No. 0938-0600 MEDICARE CREDIT BALANCE REPORT CERTIFICATION PAGE The Credit Balance Report is required under the authority of sections 1815(a),
Inpatient and Outpatient Services Billing. Presented by EDS Provider Field Consultants
Inpatient and Outpatient Services Billing Presented by EDS Provider Field Consultants October 2007 Agenda Objectives NPI New Paper Claim Form Who bills on a UB-04 Claim Form? Inpatient Claims Reimbursement
INSTITUTIONAL. billing module
INSTITUTIONAL billing module UB-92 Billing Module Basic Rules... 2 Before You Begin... 2 Reimbursement and Co-payment... 2 How to Complete the UB-92... 5 1 Basic Rules Instructions for completing the UB-92
Claims Processing Instructions for Inlier Bills and Cost Outlier Bills with Benefits Exhausted
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services ICD-10 Medicare Severity Diagnosis Related Grouper (MS-DRG), version 30.0 (FY 2013) mainframe and PC software is now available.
Medicaid. Important Contact Information. In This Issue
In This Issue Medicare & Medicaid Limitations Page 2 Resubmitting Denied Claims Page 2 Certain DME Under $50 Require PA Page 3 Top Reasons Claims are Returned to Providers Page 4 Medicaid New Medicaid
Medicare-Medicaid Crossover Claims FAQ
Medicare-Medicaid Crossover Claims FAQ Table of Contents 1. Benefits of Crossover Claims... 1 2. General Information... 1 3. Medicare Part B Professional Claims and DMERC Claims... 2 4. Professional Miscellaneous...
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
All Acute Care Hospitals and End-Stage Renal Disease Clinics. Subject: Billing and Claim Completion Guidelines for Renal Dialysis Services
Indiana Health Coverage Programs P R O V I D E R B U L L E T I N BT200223 MAY 29, 2002 To: All Acute Care Hospitals and End-Stage Renal Disease Clinics Subject: Billing and Claim Completion Guidelines
Instructions for submitting Claim Reconsideration Requests
Instructions for submitting Claim Reconsideration Requests A Claim Reconsideration Request is typically the quickest way to address any concern you have with how we processed your claim. With a Claim Reconsideration
ebilling Support ebilling Support webinar: ebilling terms Lifecycle of a claim
ebilling Support ebilling Support webinar: ebilling terms ebilling enrollment Lifecycle of a claim 2 Terms EDI Electronic Data Interchange Flow of electronic information, specifically claims information
Billing Medicaid as a Secondary Payer. Provider Relations / Second quarter 2015
Billing Medicaid as a Secondary Payer Provider Relations / Second quarter 2015 Agenda Other Coverage How to Identify Other Coverage and Request Coverage Updates Medicare Crossover Claims Third-Party Liability
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
HIPAA 5010 March 30 th National Call: Provider Testing and Readiness Resource Mailbox Questions and Answers
HIPAA 5010 March 30 th National Call: Provider Testing and Readiness Resource Mailbox Questions and Answers Background: As mentioned on previous HIPAA 5010 national calls, there is a resource box that
Claims Correction Menu Options 2. Access the Claims Correction Menu 2. Correcting Claims 3. Correcting a HIC Number: 9. Deleting Revenue Code Lines 10
Claims Correction Menu Options 2 Access the Claims Correction Menu 2 Correcting Claims 3 Correcting a HIC Number: 9 Deleting Revenue Code Lines 10 Adding Revenue Code Lines 10 Suppress View 11 Adjusting
Ambulatory Surgery Center (ASC) Billing Instructions
All related services performed by an ambulatory surgery center must be billed on the UB04 claim form following the instructions listed below. Tips Claim Form Completion Claims for ASC covered services
How to read the paper remittance advice. How to review claim and adjustment information How to correct overpayments and underpayments
How to read the paper remittance advice How to review claim and adjustment information How to correct overpayments and underpayments Overview DMAP mails the paper Remittance Advice (RA) weekly. It tells
Top 50 Billing Error Reason Codes With Common Resolutions (09-12)
Top 50 Billing Error Reason Codes With Common Resolutions (09-12) On the following table you will find the top 50 Error Reason Codes with Common Resolutions for denied claims at Virginia Medicaid. This
Direct Data Entry Quick Reference
Direct Data Entry Quick Reference Wisconsin Physicians Service Insurance Corporation QUICK REFERENCES AND OVERVIEWS Common Claim Status/Locations Quick-Reference Guide... 2 Reason Code Overview... 2 Status
837 I Health Care Claim Institutional
837 I Health Care Claim Institutional Revision Number Date Summary of Changes 6.0 5/27/04 Verbiage changes throughout the companion guide 7.0 06/29/04 Updated to include the appropriate AmeriHealth qualifier
How To Pay For A Medical Procedure In The United States
ANSI REASON CODES Reason codes, and the text messages that define those codes, are used to explain why a claim may not have been paid in full. For instance, there are reason codes to indicate that a particular
MEDICARE CROSSOVER PROCESS FREQUENTLY ASKED QUESTIONS
MEDICARE CROSSOVER PROCESS FREQUENTLY ASKED QUESTIONS QUESTION 1. What is meant by the crossover payment? ANSWER When Medicaid providers submit claims to Medicare for Medicare/Medicaid beneficiaries, Medicare
HCPCS codes should be used to describe outpatient diagnostic laboratory procedures (revenue codes 300 to 319).
6How Do I Bill Tribal Outpatient Hospital Services? Complete the UB-04 form for outpatient hospital services. Refer to How do I complete the UB-04? in the Billing Guidelines section for specific information
Remittance and Status (R&S) Reports
Remittance and Status (R&S) Reports Chapter.1 R&S Report Information........................................................... -2.1.1 Electronic Remittance and Status (ER&S) Reports.............................
September 19, 2012. Dialysis Facility Reimbursement
September 19, 2012 Dialysis Facility Reimbursement Current EGID Reimbursement Dialysis providers are currently reimbursed under the outpatient portion of EGID s facility contract. Network providers receive
Institutional Claim Billing Reimbursement. HP Provider Relations/October 2013
Institutional Claim Billing Reimbursement HP Provider Relations/October 2013 Agenda Objectives Institutional Claim Basics Inpatient Claim Payment Outpatient Claim Payment Enhanced Code Auditing Billing
New York State UB-04 Billing Guidelines
New York State UB-04 Billing Guidelines [Type text] [Type text] [Type text] Version 2014 01 03/27/2014 EMEDNY INFORMATION emedny is the name of the New York State Medicaid system. The emedny system allows
Note: The number in parenthesis corresponds to the number of the variable on the CMS Version K file documentation. 1
1 Patient ID (patient_id) SEER Cases (Patient ID) 11 Use First 10 Characters only for SEER cases. 1 Registry 2 02 = Connecticut 20 = Detroit 21 = Hawaii 22 = Iowa 23 = New Mexico 25 = Seattle 26 = Utah
Workshop Participant Guide. Medicaid: Beyond the Basics. Presented by: v2015 0714
Workshop Participant Guide Medicaid: Beyond the Basics Presented by: v2015 0714 Contents Texas Medicaid... 1 Third-Party Resources... 2 Medicaid Electronic Programs... 5 Electronic Health Records Incentive
Medicare Claims Processing Manual Chapter 27 - Contractor Instructions for CWF
Medicare Claims Processing Manual Chapter 27 - Contractor Instructions for CWF Transmittals for Chapter 27 Table of Contents (Rev. 3213, 03-06-15) 10 - General Information About the Common Working File
SECTION 6: CLAIMS FILING TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1
SECTION 6: CLAIMS FILING TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 OCTOBER 2015 TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 OCTOBER 2015 SECTION 6: CLAIMS FILING Table of Contents 6.1 Claims
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
CMS Medicare Manual System
CMS Medicare Manual System Pub. 100-6 Financial Management Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 5 Date: AUGUST 30, 2002 CHAPTERS REVISED
UB-04, Inpatient / Outpatient
UB-04, Inpatient / Outpatient Hospital (Inpatient and Outpatient), Hospice (Nursing Home and Home Services), Home Health, Rural Health linic, Federally Qualified Health enter, IF/MR, Birthing enter, and
Note: The number in parenthesis corresponds to the number of the variable on the CMS version K file documentation. 1
1 Patient ID (patient_id) SEER Cases (Patient ID) 11 Use First 10 Characters only for SEER cases. 1 Registry 2 02 = Connecticut 20 = Detroit 21 = Hawaii 22 = Iowa 23 = New Mexico 25 = Seattle 26 = Utah
Chapter 6 Policies and Procedures Unit 1: Other Party Liability
Chapter 6 Policies and Procedures Unit 1: Other Party Liability In This Unit Topic See Page Unit 1: Other Party Liability Coordination of Benefits 2 Frequently Asked Questions About COB 5 6.1 Coordination
Medicare Claims Processing Manual
Medicare Claims Processing Manual Chapter 8 - Outpatient ESRD Hospital, Independent Facility, and Physician/Supplier Claims Transmittals for Chapter 8 Table of Contents (Rev. 3311, 08-06-15) 10 - General
Medicare Financial Management Manual
Medicare Financial Management Manual Chapter 5 - Financial Reporting Table of Contents (Rev. 236, 06-13-14) Transmittals for Chapter 5 10 - Checks Paid Method - General 20 - Summary of Procedures 30 -
CareFirst ICD-10 Claim Submission Guidelines
CareFirst ICD-10 Claim Submission Guidelines Introduction The U.S. Department of Health and Human (HHS) has released a HIPAA administration simplification mandate requiring all HIPAA entities to adopt
Chapter 6. Billing on the UB-04 Claim Form
Chapter 6 This Page Intentionally Left Blank Chapter: 6 Page: 6-3 INTRODUCTION The UB-04 claim form is used to bill for all hospital inpatient, outpatient, and emergency room services. Dialysis clinic,
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
Home Health & Hospice. Claims Correction. Fiscal Intermediary Standard System (FISS) Guide. Chapter 5. February 2015 CGS
Fiscal Intermediary Standard System (FISS) Guide Chapter 5 February 2015 CGS Table of Contents Menu Options... 1 Access the Menu... 1 Correcting Claims... 2 Correcting a HICN... 10 Deleting Revenue Code
FAQ ICD 10. Categories: Compliance Billing General Claims Testing COMPLIANCE: Q. When is the ICD 10 compliance deadline? A.
FAQ ICD 10 Categories: Compliance Billing General Claims Testing COMPLIANCE: Q. When is the ICD 10 compliance deadline? A. October 1, 2015 Q. What does ICD 10 compliance mean? A. IDC 10 compliance means
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
Medicare Claims Processing Manual Chapter 10 - Home Health Agency Billing
Medicare Claims Processing Manual Chapter 10 - Home Health Agency Billing Table of Contents (Rev. 3268, 05-29-15) Transmittals for Chapter 10 10 - General Guidelines for Processing Home Health Agency (HHA)
Medicare Secondary Payer (MSP) Manual Chapter 3 - MSP Provider, Physician, and Other Supplier Billing Requirements
Medicare Secondary Payer (MSP) Manual Chapter 3 - MSP Provider, Physician, and Other Supplier Billing Requirements Transmittals for Chapter 3 Table of Contents (Rev. 87, 08-03-12) 10 - General 10.1 - Limitation
Remittance Advice Remark Code. MMIS EOB Code. Claim Adjustment Reason Code. MMIS EOB Description
Reason 4 7 The procedure code modifier listed on your claim is either invalid or the RBRVS payment rules do not allow this procedure to be billed 4 45 Modifier is invalid for the procedure code billed.
835 Health Care Claim Payment/Advice Companion Guide
835 Health Care Claim Payment/Advice Companion Guide HIPAA/V5010X221A1/835 Version: 1.2 Company: Blue Cross of Idaho Created: 07/18/2014 1.1 Disclaimer Blue Cross of Idaho (BCI) created this Companion
Common Medicare Billing Mistakes Systems and protocols necessary to help prevent and overpayment Best practices in resolving an overpayment
Bill J. Ulrich, President / CEO Consolidated Billing Services Inc. Pat Newberry, Director of Clinical Education AIS Inc. Common Medicare Billing Mistakes Systems and protocols necessary to help prevent
Presented by Rewa Cooper, Patient Access Director Western Medical Center Santa Ana
Prepared by Ana Ventura, Government Programs Manager IHHI Central Business Office Presented by Rewa Cooper, Patient Access Director Western Medical Center Santa Ana Resources: CMS.GOV and PalmettoGBA.COM
INSTITUTIONAL. [Type text] [Type text] [Type text] Version 2015-01
![INSTITUTIONAL. [Type text] [Type text] [Type text] Version 2015-01](/thumbs/40/21640943.jpg "INSTITUTIONAL. [Type text] [Type text] [Type text] Version 2015-01")
New York State Medicaid General Billing Guidelines [Type text] [Type text] [Type text] Version 2015-01 10/1/2015 EMEDNY INFORMATION emedny is the name of the electronic New York State Medicaid system.
on the status of a claim previously submitted to CMS for processing. A code that identifies the category a claim falls within.
270 Health Care Eligibility Benefit Inquiry 271 Health Care Eligibility Benefit Response 276 Health Care Claims Status Request 277 Health Care Claims Status Response 278 Health Care Services Request for
837 Institutional Health Care Claim. Section 1 837I Institutional Health Care Claim: Basic Instructions
Companion Document 837I 837 Institutional Health Care Claim This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not
837 I Health Care Claim HIPAA 5010A2 Institutional
837 I Health Care Claim HIPAA 5010A2 Institutional Revision Number Date Summary of Changes 1.0 5/20/11 Original 1.1 6/14/11 Added within the timeframes required by applicable law to page 32. Minor edits
Prescription Drug Program
Prescription Drug Program August 2011 This publication supersedes all previous pharmacy provider handbooks. Published by the Montana Department of Public Health & Human Services, July 2001. Updated October
Glossary of Billing Terms
Glossary of Billing Terms Guide to Reading & Understanding Your Bill Account Number - number the patient's visit (account) is given by the hospital or medical provider for documentation and billing purposes.
Frequently Asked Questions on the Medicare FQHC PPS 1
Frequently Asked Questions on the Medicare FQHC PPS 1 (Rev. 12-1-15) Topics FQHC PPS Rate and GAFs New Patient, IPPE, and AWV Adjustments Per-diem Payment Exceptions FQHC PPS Payment Codes Preventive Services
Managed Care Trading Partner Testing Packet. Managed Care Trading Partners
Managed Care Trading Partner Testing Packet Information in this ForwardHealth Managed Care Trading Partner Testing Packet is provided to ForwardHealth managed care s who intend to exchange electronic health
Please follow these suggestions in order to facilitate timely reimbursement of claims and to avoid timely filing issues:
Claims/Payment Section K-1 New Claims Submissions All claims must be submitted and received by Molina Healthcare of New Mexico, Inc. (Molina Healthcare) within ninety (90) days from the date of service
UB-04 Institutional Claim. HP Provider Relations October 2012
UB-04 Institutional Claim HP Provider Relations October 2012 Agenda Objectives Types of UB-04 claims Providers using UB-04 claim form UB-04 required fields on paper claims Enhanced code auditing Upcoming
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
Third Party Liability
INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Third Party Liability L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 1 7 P U B L I S H E D : F E B R U A R Y 2 5, 2 0 1 6 P
CMS 1500 Training 101
CMS 1500 Training 101 HP Enterprise Services Learning Objective Welcome, this training presentation will educate you on how to complete a CMS 1500 claim form; this includes a detailed explanation of all
CMS-1500 PART B MEDICARE ADVANTAGE PLAN BILLING INSTRUCTIONS
Department of Health and Mental Hygiene Office of Systems, Operations & Pharmacy Medical Care Programs CMS-1500 PART B MEDICARE ADVANTAGE PLAN BILLING INSTRUCTIONS Effective September, 2008 TABLE OF CONTENTS
Professional Providers... 27
General Regulations... 2 Disputes... 4 Appeal Process (External Review)... 6 Timely Filing*... 7 Coordination of Benefits... 8 MEDICARE Crossover... 9 Facility Providers... 10 Claim Filing: UB-04...10
SECTION 6: CLAIMS FILING
TEXAS MEDICAID PROVIDER PROCEDURES MANUAL: VOL. 1 SECTION 6: CLAIMS FILING 6.1 Claims Information............................................................... 6-5 6.1.1 TMHP Processing Procedures.......................................................
Claim Adjustment Reason Codes and Remittance Advice Remark Codes (CARCs and RARCs)--Effective 09/05/2015
EOB EOB DESCRIPTION ADJUSTMENT ADJUSTMENT REASON DESCRIPTION DESCRIPTION REASON 0203 MEMBER I.D. NUMBER 31 PATIENT CANNOT BE IDENTIFIED AS OUR INSURED. MISSING/INVALID 0204 HOSPITAL DISCHARGE DATE INVALID
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
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:
SUBMITTING OTHER PAYER INFORMATION ON PROFESSIONAL CLAIMS VIA THE MITS WEB PORTAL
Submitting Other Payer Information MITS IS LIVE! Release Date: April 15, 2013 SUBMITTING OTHER PAYER INFORMATION ON PROFESSIONAL CLAIMS VIA THE MITS WEB PORTAL Considering Medicaid is the payer of last
REV. JULY 2, 2013 NEBRASKA DEPARTMENT OF MEDICAID SERVICES MANUAL LETTER # 54-2013 HEALTH AND HUMAN SERVICES 471 NAC 3-000
REV. JULY 2, 2013 NEBRASKA DEPARTMENT OF MEDICAID SERVICES MANUAL LETTER # 54-2013 HEALTH AND HUMAN SERVICES 471 NAC 3-000 CHAPTER 3-000 PAYMENT FOR MEDICAID SERVICES 3-001 Definitions: Claim means a request
Direct Data Entry (DDE) Manual
Direct Data Entry (DDE) Manual Wisconsin Physicians Service Insurance Corporation CHAPTER 1: INTRODUCTION TO DDE Introduction to Direct Data Entry (DDE)... 2 Acronyms and Abbreviations... 3 Movement within
Direct Data Entry (DDE)
Section 6 Direct Data Entry (DDE) Sign-on Instructions Revised May 7, 2014. 2014 Copyright, CGS Administrators, LLC. Table of Contents Section 6 Claim Correction 3 Online Claims Correction 3 Claim Summary
How To Get A Medicare Plan For A Single Payer Health Insurance Plan
J6: Home Health Billing Basics 1493_1013 Disclaimer National Government Services, Inc. has produced this material as an informational reference for providers furnishing services in our contract jurisdiction.
Inpatient Transfers, Discharges and Readmissions July 19, 2012
Inpatient Transfers, Discharges and Readmissions July 19, 2012 Discharge Status Codes Two-digit code Identifies where the patient is at conclusion of encounter Visit Inpatient stay End of billing cycle
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.
The benefits of electronic claims submission improve practice efficiencies
The benefits of electronic claims submission improve practice efficiencies Electronic claims submission vs. manual claims submission An electronic claim is a paperless patient claim form generated by computer
Ambulatory Surgery Centers Billing Instructions
Health and Recovery Services Administration (HRSA) Ambulatory Surgery Centers Billing Instructions About this publication This publication supersedes all previous billing instructions for Ambulatory Surgery
National Coverage Determination (NCD) for Cardiac Rehabilitation Programs for Chronic Heart Failure (20.10.1)
National Coverage Determination (NCD) for Cardiac Rehabilitation Programs for Chronic Heart Failure (20.10.1) Tracking Information Publication Number 100-3 Manual Section Number 20.10.1 Manual Section
Submit Fee-for-Service Claims to Medical Assistance. Receive Timely and Accurate Payments for Covered Services
Submit Fee-for-Service Claims to Medical Assistance Receive Timely and Accurate Payments for Covered Services This Chapter shows how to: Submit claims using any of the following methods: Direct data entry
The Integrated Outpatient Code Editor I/OCE V15.0
The Integrated Outpatient Code Editor I/OCE V15.0 April 2014 Updated 1 Disclaimer Duke University Medical Center Durham, NC The comments expressed throughout this presentation are our opinions, predicated
Your Revenue Cycle It s not just billing anymore. Presented by: Candy Edie, MBA, CRCE-I
Your Revenue Cycle It s not just billing anymore Presented by: Candy Edie, MBA, CRCE-I POSITIONS Staff Accountant Chief Financial Officer Financial Systems Analyst Patient Access Director Patient Financial
UB-04 Billing Guide for PROMISe ICF/MR, ICF/ORCs and State MR Centers
October 2008 UB-04 Billing Guide for PROISe ICF/R, ICF/ORCs and State R Centers Purpose of the Document Document at Font Sizes The purpose of this document is to provide a block-by-block reference guide
CMMI Payment Bundling Initiative
CMMI Payment Bundling Initiative Table of Contents Questions & Answers... 2 Technical... 2 General... 3 Inpatient... 12 Skilled Nursing Facility (SNF)... 18 Outpatient... 20 Home Health... 23 Carrier...
Sending Electronic Secondary Claims
Sending Electronic Secondary Claims Claim Adjustment Codes When submitting secondary claims electronically, you need to add Claim Adjustment Codes (CAS). These are adjustment codes that associate any adjustment
Office of Benefits Hospital Billing Guidelines
Office of Benefits Hospital Billing Guidelines Revised 11/1/2015 TABLE OF CONTENTS Changes... 6 New Changes for 11/1/2015... 6 1. HOSPITAL BILLING OVERVIEW... 8 1.1 Instructions for Hospital Providers...
TABLE OF CONTENTS. Claims Processing & Provider Compensation
TABLE OF CONTENTS Claims Address... 2 Claim Submission... 2 Claim Payment... 2 Claim Payment Adjustments.... 2 Claim Disputes... 2 Recovery of Overpayments... 3 Balance Billing... 3 Annual Health Assessment