In this blog, Our Medical Billers and Coders shared emergency declaration blanket waivers for certain providers in SNFs and NFs.
Read More: https://bit.ly/3zrYnCv
Addressing Medical Necessity Denials and RecoupmentsPYA, P.C.
With increased denials and recoupments related to medical necessity at the forefront of discussions at this year’s American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, PYA was prepared to inform and assist providers instituting best practices to address medical necessity denials. PYA Principal Denise Hall-Gaulin co-presented “Medical Status-Current Status/Key Best Practices in Prevention of Medical Necessity Denials and Recoupments” with Michael Spake, VP of External Affairs and Chief Compliance and Integrity Officer at Lakeland Regional Health.
The presentation included:
A discussion of medical necessity—what it means and what it affects
Information regarding medical necessity determinations and criteria for determination
Definitions for categorically excluded services
Criteria for admission (skilled nursing facilities and inpatient rehabilitation facilities included)
Medical Necessity-- What it Means and 2018 UpdatePYA, P.C.
This presentation addresses the concerns for instituting best practices in tackling medical necessity denials. Including what it means and what it affects, an update on 2018 CMS medical necessity determinations and new initiatives, and details regarding the types of, and criteria for, medical necessity determinations. Admission criteria for skilled nursing facilities and inpatient rehabilitation facilities, as well as the use of Advanced Beneficiary Notification and Hospital-Issued Notice of Non-Coverage (including the outcomes and penalties for not using ABNs or HINNs) are also discussed.
Telehealth, Coding and Billing Guidance for COVID-19Kareo
Kareo’s Subject Matter Expert for Billing, Terri Joy, MBA, CPC, CGSC, COC, CPC-I will provide you with everything you need to know about telehealth, coding and billing for COVID-19.
In this webinar, Terri will:
-Discuss new and changing government regulations around telehealth services
-How to bill for COVID-19 services
-Best practices for leveraging technology to keep your patients and staff safe and healthy
Jugement cour suprême pour travailleurs de santéSociété Tripalio
Jugement de la Cour Suprême sur la vaccination obligatoire des travailleurs de santé. Ce jugement infirme l'obligation vaccinale et constitue un revers pour Joe Biden.
A presentation designed to train individuals in the rationale and defense of Medically Necessary Documentation as it pertains to CMS guidelines in an Inpatient Rehabilitation Facility. Designing short and long term goals to improve documentation for defending Medical Necessity under RAC / MAC audits.
http1500cms.comBECAUSE THIS FORM IS USED BY VARIOUS .docxpooleavelina
http://1500cms.com/
BECAUSE THIS FORM IS USED BY VARIOUS GOVERNMENT AND PRIVATE HEALTH PROGRAMS, SEE SEPARATE INSTRUCTIONS ISSUED BY
APPLICABLE PROGRAMS.
NOTICE: Any person who knowingly files a statement of claim containing any misrepresentation or any false, incomplete or misleading information may
be guilty of a criminal act punishable under law and may be subject to civil penalties.
REFERS TO GOVERNMENT PROGRAMS ONLY
MEDICARE AND CHAMPUS PAYMENTS: A patient’s signature requests that payment be made and authorizes release of any information necessary to process
the claim and certifies that the information provided in Blocks 1 through 12 is true, accurate and complete. In the case of a Medicare claim, the patient’s signature
authorizes any entity to release to Medicare medical and nonmedical information, including employment status, and whether the person has employer group health
insurance, liability, no-fault, worker’s compensation or other insurance which is responsible to pay for the services for which the Medicare claim is made. See 42
CFR 411.24(a). If item 9 is completed, the patient’s signature authorizes release of the information to the health plan or agency shown. In Medicare assigned or
CHAMPUS participation cases, the physician agrees to accept the charge determination of the Medicare carrier or CHAMPUS fiscal intermediary as the full charge,
and the patient is responsible only for the deductible, coinsurance and noncovered services. Coinsurance and the deductible are based upon the charge
determination of the Medicare carrier or CHAMPUS fiscal intermediary if this is less than the charge submitted. CHAMPUS is not a health insurance program but
makes payment for health benefits provided through certain affiliations with the Uniformed Services. Information on the patient’s sponsor should be provided in those
items captioned in “Insured”; i.e., items 1a, 4, 6, 7, 9, and 11.
BLACK LUNG AND FECA CLAIMS
The provider agrees to accept the amount paid by the Government as payment in full. See Black Lung and FECA instructions regarding required procedure and
diagnosis coding systems.
SIGNATURE OF PHYSICIAN OR SUPPLIER (MEDICARE, CHAMPUS, FECA AND BLACK LUNG)
I certify that the services shown on this form were medically indicated and necessary for the health of the patient and were personally furnished by me or were furnished
incident to my professional service by my employee under my immediate personal supervision, except as otherwise expressly permitted by Medicare or CHAMPUS
regulations.
For services to be considered as “incident” to a physician’s professional service, 1) they must be rendered under the physician’s immediate personal supervision
by his/her employee, 2) they must be an integral, although incidental part of a covered physician’s service, 3) they must be of kinds commonly furnished in physician’s
offices, and 4) the services of nonphysicians must be included on the physician’s bills.
For CHA ...
Addressing Medical Necessity Denials and RecoupmentsPYA, P.C.
With increased denials and recoupments related to medical necessity at the forefront of discussions at this year’s American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, PYA was prepared to inform and assist providers instituting best practices to address medical necessity denials. PYA Principal Denise Hall-Gaulin co-presented “Medical Status-Current Status/Key Best Practices in Prevention of Medical Necessity Denials and Recoupments” with Michael Spake, VP of External Affairs and Chief Compliance and Integrity Officer at Lakeland Regional Health.
The presentation included:
A discussion of medical necessity—what it means and what it affects
Information regarding medical necessity determinations and criteria for determination
Definitions for categorically excluded services
Criteria for admission (skilled nursing facilities and inpatient rehabilitation facilities included)
Medical Necessity-- What it Means and 2018 UpdatePYA, P.C.
This presentation addresses the concerns for instituting best practices in tackling medical necessity denials. Including what it means and what it affects, an update on 2018 CMS medical necessity determinations and new initiatives, and details regarding the types of, and criteria for, medical necessity determinations. Admission criteria for skilled nursing facilities and inpatient rehabilitation facilities, as well as the use of Advanced Beneficiary Notification and Hospital-Issued Notice of Non-Coverage (including the outcomes and penalties for not using ABNs or HINNs) are also discussed.
Telehealth, Coding and Billing Guidance for COVID-19Kareo
Kareo’s Subject Matter Expert for Billing, Terri Joy, MBA, CPC, CGSC, COC, CPC-I will provide you with everything you need to know about telehealth, coding and billing for COVID-19.
In this webinar, Terri will:
-Discuss new and changing government regulations around telehealth services
-How to bill for COVID-19 services
-Best practices for leveraging technology to keep your patients and staff safe and healthy
Jugement cour suprême pour travailleurs de santéSociété Tripalio
Jugement de la Cour Suprême sur la vaccination obligatoire des travailleurs de santé. Ce jugement infirme l'obligation vaccinale et constitue un revers pour Joe Biden.
A presentation designed to train individuals in the rationale and defense of Medically Necessary Documentation as it pertains to CMS guidelines in an Inpatient Rehabilitation Facility. Designing short and long term goals to improve documentation for defending Medical Necessity under RAC / MAC audits.
http1500cms.comBECAUSE THIS FORM IS USED BY VARIOUS .docxpooleavelina
http://1500cms.com/
BECAUSE THIS FORM IS USED BY VARIOUS GOVERNMENT AND PRIVATE HEALTH PROGRAMS, SEE SEPARATE INSTRUCTIONS ISSUED BY
APPLICABLE PROGRAMS.
NOTICE: Any person who knowingly files a statement of claim containing any misrepresentation or any false, incomplete or misleading information may
be guilty of a criminal act punishable under law and may be subject to civil penalties.
REFERS TO GOVERNMENT PROGRAMS ONLY
MEDICARE AND CHAMPUS PAYMENTS: A patient’s signature requests that payment be made and authorizes release of any information necessary to process
the claim and certifies that the information provided in Blocks 1 through 12 is true, accurate and complete. In the case of a Medicare claim, the patient’s signature
authorizes any entity to release to Medicare medical and nonmedical information, including employment status, and whether the person has employer group health
insurance, liability, no-fault, worker’s compensation or other insurance which is responsible to pay for the services for which the Medicare claim is made. See 42
CFR 411.24(a). If item 9 is completed, the patient’s signature authorizes release of the information to the health plan or agency shown. In Medicare assigned or
CHAMPUS participation cases, the physician agrees to accept the charge determination of the Medicare carrier or CHAMPUS fiscal intermediary as the full charge,
and the patient is responsible only for the deductible, coinsurance and noncovered services. Coinsurance and the deductible are based upon the charge
determination of the Medicare carrier or CHAMPUS fiscal intermediary if this is less than the charge submitted. CHAMPUS is not a health insurance program but
makes payment for health benefits provided through certain affiliations with the Uniformed Services. Information on the patient’s sponsor should be provided in those
items captioned in “Insured”; i.e., items 1a, 4, 6, 7, 9, and 11.
BLACK LUNG AND FECA CLAIMS
The provider agrees to accept the amount paid by the Government as payment in full. See Black Lung and FECA instructions regarding required procedure and
diagnosis coding systems.
SIGNATURE OF PHYSICIAN OR SUPPLIER (MEDICARE, CHAMPUS, FECA AND BLACK LUNG)
I certify that the services shown on this form were medically indicated and necessary for the health of the patient and were personally furnished by me or were furnished
incident to my professional service by my employee under my immediate personal supervision, except as otherwise expressly permitted by Medicare or CHAMPUS
regulations.
For services to be considered as “incident” to a physician’s professional service, 1) they must be rendered under the physician’s immediate personal supervision
by his/her employee, 2) they must be an integral, although incidental part of a covered physician’s service, 3) they must be of kinds commonly furnished in physician’s
offices, and 4) the services of nonphysicians must be included on the physician’s bills.
For CHA ...
PYA Webinar: “Additional Expansion of Medicare Telehealth Coverage During COV...PYA, P.C.
Late on March 30, CMS released an interim rule which, among other things, significantly expands Medicare telehealth coverage, even beyond the initial Section 1135 waivers. PYA’s complimentary one-hour webinar explained these changes and how they make telehealth an even more attractive option in response to the COVID-19 pandemic.
PYA Principals Martie Ross and Valerie Rock addressed the latest developments, including:
New reimbursement for telephone-only services.
Broader coverage for remote patient monitoring.
New payments for rural health clinics and federally qualified health centers.
Use of telehealth to meet supervision requirements.
New rules regarding coding and billing as well as the changed payment rates for telehealth services.
The webinar took place Friday April 3, 2020, at 11 a.m. EDT.
Webinar: “Making It Work—Physician Compensation During the COVID-19 Pandemic”PYA, P.C.
What to do with your physician compensation plan in the face of the COVID-19 pandemic? It’s a question that leaves administrators searching for answers.
PYA Principal Angie Caldwell and Senior Manager Katie Culver introduced several key considerations for provider compensation during and after the COVID-19 pandemic. In PYA’s complimentary webinar, they:
Summarized the current environment impacting physician compensation associated with the pandemic.
Provided an overview of the Stark Blanket Waivers and opportunities created for physician compensation.
Described restoration and recovery strategies for physician resources.
PYA hosted this one-hour webinar Tuesday, April 28, 2020, at 11 a.m. EDT in conjunction with the Florida Hospital Association.
October 24, 2011 CMS published changes to many of the hospital Conditions of Participation (CoP) requirements. In March 2012, CMs provided an “Advanced Copy” in a Transmittal of the new Appendix A. Although no changes were made to the CMS CoP under “Patient Rights-Advance Directives” §489.102, significant changes were made to the “Interpretive Guidelines” and “Survey Procedures.” CMS took the opportunity to expand patient’s rights related to advance directives, (AD). The focus of the changes to advance directives centered on the incapacitated patient and the designation of a representative for decisions related to healthcare matters. The Interpretive Guidelines indicate that the decision maker need not be the same person as the designated representative. Additionally, if the patient does not have an AD designating a “representative for decision making,” the hospital follows state rules for designation of a decision maker, i.e. spouse, parents, children, siblings, etc.
Getting Started With Telemedicine #3 - ReimbursementVSee
Visit: https://vsee.com/blog/telemedicine-101-reimbursement/ for more info
Anjali and Mary Jean will present on the changing landscape of telemedicine reimbursement what it was in the past, where it is now during the National Emergency, and probable future outcomes based on her experience and insight. Additionally, she will provide practical guidance on coding to avoid fraud and abuse issues to avoid post-pandemic audits and investigations
Learning Objectives:
Allowable Telemedicine Reimbursement Past, Present, Future
Telemedicine Reimbursement Codes and How to Example
Considerations for Practicing Across State Lines and Documentation
Avoiding investigations: Fraud & Abuse
Preauthorization is a process through which a request for provisional affirmation of coverage is submitted for review before a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) item is furnished to a beneficiary and before a claim is submitted for payment. Preauthorization helps ensure that applicable coverage, payment, and coding rules are met before supplies are delivered.
Preauthorization is a process through which a request for provisional affirmation of coverage is submitted for review before a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) item is furnished to a beneficiary and before a claim is submitted for payment. Preauthorization helps ensure that applicable coverage, payment, and coding rules are met before supplies are delivered. Preauthorization may be needed before certain services can be rendered or equipment supplied.
Basics of Preauthorization for DME.pptxScottFeldberg
Preauthorization is a process through which a request for provisional affirmation of coverage is submitted for review before a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) item is furnished to a beneficiary and before a claim is submitted for payment. Preauthorization helps ensure that applicable coverage, payment, and coding rules are met before supplies are delivered.
Basics of Preauthorization for DME.pptxScottFeldberg
Preauthorization is a process through which a request for provisional affirmation of coverage is submitted for review before a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) item is furnished to a beneficiary and before a claim is submitted for payment. Preauthorization helps ensure that applicable coverage, payment, and coding rules are met before supplies are delivered. Preauthorization may be needed before certain services can be rendered or equipment supplied.
Common Challenges in Dermatology Billing and How to Overcome.pptxalicecarlos1
Common Challenges in Dermatology Billing and How to Overcome?
Dermatology billing faces challenges like incorrect coding, denied claims, and changing insurance policies. Ensure staff are trained in dermatology-specific codes and use robust systems for checking claims before submission. Stay informed about insurance updates and communicate clearly with patients about their financial responsibilities. Medical Billers and Coders (MBC) can help by ensuring accurate coding, timely claim submission, and effective follow-up on denied claims, allowing you to focus on patient care.
Read more about How to Overcome Challenges in Dermatology: https://shorturl.at/D7ANX
#DermatologyBilling #MedicalBilling #RevenueCycleManagement #HealthcareBilling #BillingChallenges #MedicalCoders #MedicalBillersAndCoders
ICD-11 and Its Impact on OB-GYN Billing in 2024.pptxalicecarlos1
Improving OB-GYN billing in 2024 hinges on ICD-11, WHO’s 11th health data edition reshaping cause-of-death recording by the World Health Organization. This latest version plays a crucial role in capturing health data and accurately documenting the causes of death.
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Similar to COVID-19 Emergency Declaration Blanket Waivers for SNFs and NFs.pptx
PYA Webinar: “Additional Expansion of Medicare Telehealth Coverage During COV...PYA, P.C.
Late on March 30, CMS released an interim rule which, among other things, significantly expands Medicare telehealth coverage, even beyond the initial Section 1135 waivers. PYA’s complimentary one-hour webinar explained these changes and how they make telehealth an even more attractive option in response to the COVID-19 pandemic.
PYA Principals Martie Ross and Valerie Rock addressed the latest developments, including:
New reimbursement for telephone-only services.
Broader coverage for remote patient monitoring.
New payments for rural health clinics and federally qualified health centers.
Use of telehealth to meet supervision requirements.
New rules regarding coding and billing as well as the changed payment rates for telehealth services.
The webinar took place Friday April 3, 2020, at 11 a.m. EDT.
Webinar: “Making It Work—Physician Compensation During the COVID-19 Pandemic”PYA, P.C.
What to do with your physician compensation plan in the face of the COVID-19 pandemic? It’s a question that leaves administrators searching for answers.
PYA Principal Angie Caldwell and Senior Manager Katie Culver introduced several key considerations for provider compensation during and after the COVID-19 pandemic. In PYA’s complimentary webinar, they:
Summarized the current environment impacting physician compensation associated with the pandemic.
Provided an overview of the Stark Blanket Waivers and opportunities created for physician compensation.
Described restoration and recovery strategies for physician resources.
PYA hosted this one-hour webinar Tuesday, April 28, 2020, at 11 a.m. EDT in conjunction with the Florida Hospital Association.
October 24, 2011 CMS published changes to many of the hospital Conditions of Participation (CoP) requirements. In March 2012, CMs provided an “Advanced Copy” in a Transmittal of the new Appendix A. Although no changes were made to the CMS CoP under “Patient Rights-Advance Directives” §489.102, significant changes were made to the “Interpretive Guidelines” and “Survey Procedures.” CMS took the opportunity to expand patient’s rights related to advance directives, (AD). The focus of the changes to advance directives centered on the incapacitated patient and the designation of a representative for decisions related to healthcare matters. The Interpretive Guidelines indicate that the decision maker need not be the same person as the designated representative. Additionally, if the patient does not have an AD designating a “representative for decision making,” the hospital follows state rules for designation of a decision maker, i.e. spouse, parents, children, siblings, etc.
Getting Started With Telemedicine #3 - ReimbursementVSee
Visit: https://vsee.com/blog/telemedicine-101-reimbursement/ for more info
Anjali and Mary Jean will present on the changing landscape of telemedicine reimbursement what it was in the past, where it is now during the National Emergency, and probable future outcomes based on her experience and insight. Additionally, she will provide practical guidance on coding to avoid fraud and abuse issues to avoid post-pandemic audits and investigations
Learning Objectives:
Allowable Telemedicine Reimbursement Past, Present, Future
Telemedicine Reimbursement Codes and How to Example
Considerations for Practicing Across State Lines and Documentation
Avoiding investigations: Fraud & Abuse
Preauthorization is a process through which a request for provisional affirmation of coverage is submitted for review before a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) item is furnished to a beneficiary and before a claim is submitted for payment. Preauthorization helps ensure that applicable coverage, payment, and coding rules are met before supplies are delivered.
Preauthorization is a process through which a request for provisional affirmation of coverage is submitted for review before a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) item is furnished to a beneficiary and before a claim is submitted for payment. Preauthorization helps ensure that applicable coverage, payment, and coding rules are met before supplies are delivered. Preauthorization may be needed before certain services can be rendered or equipment supplied.
Basics of Preauthorization for DME.pptxScottFeldberg
Preauthorization is a process through which a request for provisional affirmation of coverage is submitted for review before a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) item is furnished to a beneficiary and before a claim is submitted for payment. Preauthorization helps ensure that applicable coverage, payment, and coding rules are met before supplies are delivered.
Basics of Preauthorization for DME.pptxScottFeldberg
Preauthorization is a process through which a request for provisional affirmation of coverage is submitted for review before a durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) item is furnished to a beneficiary and before a claim is submitted for payment. Preauthorization helps ensure that applicable coverage, payment, and coding rules are met before supplies are delivered. Preauthorization may be needed before certain services can be rendered or equipment supplied.
Common Challenges in Dermatology Billing and How to Overcome.pptxalicecarlos1
Common Challenges in Dermatology Billing and How to Overcome?
Dermatology billing faces challenges like incorrect coding, denied claims, and changing insurance policies. Ensure staff are trained in dermatology-specific codes and use robust systems for checking claims before submission. Stay informed about insurance updates and communicate clearly with patients about their financial responsibilities. Medical Billers and Coders (MBC) can help by ensuring accurate coding, timely claim submission, and effective follow-up on denied claims, allowing you to focus on patient care.
Read more about How to Overcome Challenges in Dermatology: https://shorturl.at/D7ANX
#DermatologyBilling #MedicalBilling #RevenueCycleManagement #HealthcareBilling #BillingChallenges #MedicalCoders #MedicalBillersAndCoders
ICD-11 and Its Impact on OB-GYN Billing in 2024.pptxalicecarlos1
Improving OB-GYN billing in 2024 hinges on ICD-11, WHO’s 11th health data edition reshaping cause-of-death recording by the World Health Organization. This latest version plays a crucial role in capturing health data and accurately documenting the causes of death.
EOB: Claims Adjustment Reason Codes List
Ever looked at your medical bills and wondered why the numbers don't add up? The Claims Adjustment Reason Codes on your Explanation of Benefits (EOB) hold the answers. They explain why your insurance company might adjust or deny a claim. Understanding these codes can make navigating medical bills less confusing.
How MBC can help: Medical Billing Companies (MBC) simplify this process by decoding the reason codes for you. They ensure your claims are accurate, helping you get the most out of your insurance coverage. Let's make healthcare billing clearer together!
Learn about Claims Adjustment Reason Codes and how they are used in the healthcare industry.: https://shorturl.at/ijuvH
#MedicalBilling #HealthcareBilling #InsuranceClaims #EOB #MedicalBillingandCoding #MedicalCoding #ExpertAssistance #RCM #MBC #RevenueCycleManagement #MedicalBillersandCoders #MedicalBillingandCoding #ExplanationofBenefits
The Importance of Addressing Old AR in OBGYN Billing.pptxalicecarlos1
The Importance of Addressing Old AR in OB/GYN Billing
Learn the importance of old AR recovery in healthcare billing.: https://shorturl.at/ruQ89 Discover how addressing unpaid claims can lead to better financial health for hospitals and medical groups.
#OBGYNBilling #MedicalBilling #ARManagement #RevenueCycleManagement #MedicalCoding #HealthcareBilling #AccountsReceivable #BillingEfficiency #ClaimManagement #RevenueRecovery #HealthcareReimbursement #PatientAccounts #HealthcareBillingSolutions #PracticeManagement #BillingBestPractices #HealthcareRevenue #ARFollowUp #MedicalCollections #HealthcareCompliance #MedicalBillingServices #HealthcareClaims #BillingAccuracy #HealthcareProviders #RevenueOptimization #BillingChallenges #HealthcareFinanceManagement #ClaimsProcessing #HealthcareBillingSystem #BillingWorkflow #ARRecovery #MedicalPracticeManagement #BillingCodingIntegration
Denial Management in Medical Billing.pdfalicecarlos1
Medical Billers and Coders (MBC) is a leading revenue cycle company providing complete medical billing services. Our medical specialty-wise RCM experts ensure all the denied claims are addressed properly to receive accurate insurance collections.
Denial Management in Medical Billing.pptxalicecarlos1
Medical Billers and Coders (MBC) is a leading revenue cycle company providing complete medical billing services. Our medical specialty-wise RCM experts ensure all the denied claims are addressed properly to receive accurate insurance collections.
Revenue Leakage in Revenue Cycle Management .pdfalicecarlos1
Don't let Revenue Leakage drain your profits! Explore our carousel to uncover the critical concerns, common causes, and effective strategies for safeguarding your financial health in physician groups and hospitals.
Connect with Medical Billers and Coders for expert assistance.: https://shorturl.at/qxUX0
#HealthcareFinance #RevenueCycleManagement #FinancialWellness #RevenueLeakage #RevenueLeakage #RevenueCycle #HealthcareFinance #MedicalBilling #FinancialStability #PhysicianGroups #Hospitals #HealthcareManagement #StreamlinedProcesses #DataAnalytics #MaximizeRevenue
Tackling The Unique Challenges Of ASC Billing Services.pptxalicecarlos1
Tackling The Unique Challenges Of ASC Billing Services
Learn how ASC billing services can help Ambulatory Surgery Centers optimize revenue, cover operational costs, & provide quality patient care.
Proposed Updates for Skilled Nursing Facility Quality Reporting Program.pptxalicecarlos1
We shared here the proposed updates only for the Skilled Nursing Facility Quality Reporting Program (SNF QRP) for the year 2023.
Read More: http://bit . ly/3Zuoyn9
#SNFBilling #CodingExcellence #SkilledNursingFacilityBilling #SNF #MedicalBilling #MedicalCoding #ExpertAssistance #SNFMedicalBilling #MedicalBillingandCoding #RCM #MBC #RevenueCycleManagement #MedicalBillersandCoders #HealthcareBilling #MedicareUpdates #PatientCare #ClaimSubmission
EOB: Claims Adjustment Reason Codes List
Ever looked at your medical bills and wondered why the numbers don't add up? The Claims Adjustment Reason Codes on your Explanation of Benefits (EOB) hold the answers. They explain why your insurance company might adjust or deny a claim. Understanding these codes can make navigating medical bills less confusing.
How MBC can help: Medical Billing Companies (MBC) simplify this process by decoding the reason codes for you. They ensure your claims are accurate, helping you get the most out of your insurance coverage. Let's make healthcare billing clearer together!
Learn about Claims Adjustment Reason Codes and how they are used in the healthcare industry.: https://shorturl.at/ijuvH
#MedicalBilling #HealthcareBilling #InsuranceClaims #EOB #MedicalBillingandCoding #MedicalCoding #ExpertAssistance #RCM #MBC #RevenueCycleManagement #MedicalBillersandCoders #MedicalBillingandCoding #ExplanationofBenefits
Physician Credentialing- Worth Getting Right to Get Paid.pptxalicecarlos1
Physician credentialing is the process of organizing and verifying the professional records that qualify a doctor to practice medicine.
Read More: https://bit.ly/3FYmQSW
Top Goals for Physicians to Implement In Their Facility.pptxalicecarlos1
Let's understand how our medical billing and coding experts help with Top Goals for Physicians to Implement In Their Facilities.
Read More: https://bit.ly/3LFPThv
Expanding Medicare Telehealth Use after PHE.pptxalicecarlos1
Advanced and Affordable Ambulatory Surgery Center Billing Services in Oklahoma
ASC medical coding services tailored for maximum reimbursements. Contact us at 1-888-357-3226 our experts now to know about the benefits of partnering with us. Read Here: https://bit.ly/3OoEfGx
#ambulatorysurgerycentermedicalbilling #ascmedicalbilling #ambulatorysurgerycenterbilling #ascbillingservice #ascbillingrevenue #ascbillingservicesinusa #outsourcedascmedicalbilling #outsourcingascmedicalbilling #outsourcingascmedicalbillingservices #outsourcedascmedicalbillingcomany #ascbilling #RCM #ascbillinginoklahoma #ascbillingprocess
Cms proposed a rule for improving prior authorizationsalicecarlos1
CMS Proposed a Rule for Improving Prior Authorizations
Our billing experts are well versed with the prior authorizations process for various insurance carriers ensuing accurate collection of insurance reimbursements. To know more about our prior authorization services or overall medical billing and coding services, contact us at info@medicalbillersandcoders.com/ 888-357-3226
Click Here: https://bit.ly/3uUaAyB
#CMS #improvingpriorauthorizations #priorauthorizations #priorauthorizationsprocess #reimbursements #priorauthorizationservices #medicalbilling
Credentialing procedure for adding new provideralicecarlos1
Credentialing Procedure for Adding New Provider
Credentialing Procedure in healthcare is the process by which medical organizations verify the credentials of healthcare providers to ensure they have the required licenses, certifications, and skills to properly care for patients.
Contact us today at info@medicalbillersandcoders.com/888-357-3226 to learn how we can expedite the provider credentialing process for you.
Read More: https://bit.ly/3gOK29I
#credentialing #credentialingprocedure #providercredentialingprocess #credentialprocess #credentialingprocessinhealthcare #medicalbillingservice #RCM
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We discussed avoiding common provider credentialing mistakes which can help you to dodge malpractice suits and accreditation problems. Our credentialing team continuously takes follow up on submitted application with payers to ensure any missing or additional details. If you need any assistance in provider credentialing or revalidation process, contact us at info@medicalbillersandcoders.com/ 888-357-3226
Read More: https://bit.ly/34wLxXJ
#credential #credentialingmistake #providercredentialingmistakes #credentialingteam #providercredentialing #revalidationprocess #medicalbilling #RCM
Avoiding common provider credentialing mistakesalicecarlos1
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We discussed avoiding common provider credentialing mistakes which can help you to dodge malpractice suits and accreditation problems. Our credentialing team continuously takes follow up on submitted application with payers to ensure any missing or additional details. If you need any assistance in provider credentialing or revalidation process, contact us at info@medicalbillersandcoders.com/ 888-357-3226
Read More: https://bit.ly/34wLxXJ
#credential #credentialingmistake #providercredentialingmistakes #credentialingteam #providercredentialing #revalidationprocess #medicalbilling #RCM
Billing for transitional care managementalicecarlos1
Billing for Transitional Care Management
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Contact us at info@medicalbillersandcoders.com/ 888-357-3226
Read More: https://bit.ly/3LkC1Yn
#TCM #billingfortcm #medicare #transitionalcaremanagement #medicarebeneficiaries #medicalbillersandcoders #medicalbillingservices #medicalbilling
Billing for transitional care managementalicecarlos1
Leading Plastic Surgery Billing Service Provider in Washington - MedicalBillersandCoders.com
Streamline your Billing Services and Keep up with your Revenue Cycle Management (RCM). Click Here: https://bit.ly/3LdYSVv
Looking for a Plastic Surgery Billing Service Quote? Email us: steve@medicalbillersandcoders.com
Tell us the nature of the request; Call Now - 888-357-3226
#plasticsurgerybillingservice #washingtonplasticsurgerybillingservices #washingtonplasticsurgerybilling #washingtonplasticsurgery #medicalbillingservice #leadingplasticsurgerybilling #medicalbillingservices #washingtonplasticsurgerybillingcompanies #medicalbilling #outsourcingmedicalbilling #plasticsurgerybilling #RCM
ASC Medical Billing Services in Texas | MedicalBillersandCoders
When you outsource ASC billing services to MedicalBillersandCoders, you’ll partner with an expert ASC medical billing company that is extremely skilled in providing an extensive scope of services delivered to you in our unique and personalized manner.
Let us handle your RCM services & generate increased revenue consistently. Reach out to us on 888-357-3226 to know more about ASC billing services
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COVID-19 Emergency Declaration Blanket Waivers for SNFs and NFs.pptx
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COVID-19 Emergency Declaration Blanket Waivers for SNFs and NFs
The Trump Administration is taking aggressive actions and exercising regulatory flexibility to help healthcare
providers contain the spread of the 2019 Novel Coronavirus Disease (COVID-19). CMS is empowered to take
proactive steps through 1135 waivers as well as, where applicable, the authority granted under section 1812(f)
of the Social Security Act (the Act) and rapidly expand the Administration’s aggressive efforts against COVID-19.
As a result, the following blanket waivers are in effect, with a retroactive effective date of March 1, 2020,
through the end of the emergency declaration. CMS is ending the specific emergency declaration blanket
waivers for SNFs/NFs, inpatient hospices, ICF/IIDs, and ESRD facilities. CMS passed several temporary
emergency declaration blanket waivers for SNFs which were intended to provide healthcare providers with
extra flexibilities required to respond to the COVID-19 pandemic.
Emergency Declaration Blanket Waivers for SNFs
3-Day Prior Hospitalization
Using the authority under Section 1812(f) of the Act, CMS is waiving the requirement for a 3-day prior
hospitalization for coverage of an SNF stay, which provides temporary emergency coverage of SNF services
without a qualifying hospital stay, for those people who experience dislocations or are otherwise affected by
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COVID-19 Emergency Declaration Blanket Waivers for SNFs and NFs
COVID-19. In addition, for certain beneficiaries who recently exhausted their SNF benefits, it authorizes
renewed SNF coverage without first having to start a new benefit period (this waiver will apply only to those
beneficiaries who have been delayed or prevented by the emergency itself from commencing or completing
the process of ending their current benefit period and renewing their SNF benefits that would have occurred
under normal circumstances).
Physical Environment
CMS is Waiving Requirements Related to 42 CFR 483.90, Specifically the following:
Provided that the state has approved the location as one that sufficiently addresses safety and comfort for
patients and staff, CMS is waiving requirements under § 483.90 to allow for a non-SNF building to be
temporarily certified and available for use by an SNF in the event there are needs for isolation processes for
COVID-19 positive residents, which may not be feasible in the existing SNF structure to ensure care and
services during treatment for COVID-19 are available while protecting other vulnerable adults. CMS believes
this will also provide another measure that will free up inpatient care beds at hospitals for the most acute
patients while providing beds for those still in need of care. CMS will waive certain conditions of participation
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COVID-19 Emergency Declaration Blanket Waivers for SNFs and NFs
and certification requirements for opening an NF if the state determines there is a need to quickly stand up a
temporary COVID-19 isolation and treatment location.
CMS is also waiving requirements under 42 CFR 483.90 to temporarily allow for rooms in a long-term care
facility not normally used as a resident’s room, to be used to accommodate beds and residents for resident
care in emergencies and situations needed to help with surge capacity. Rooms that may be used for this
purpose include activity rooms, meeting/conference rooms, dining rooms, or other rooms, as long as residents
can be kept safe, and comfortable, and other applicable requirements for participation are met. This can be
done so long as it is not inconsistent with a state’s emergency preparedness or pandemic plan, or as directed
by the local or state health department.
Reporting Minimum Data Set
CMS is waiving 42 CFR 483.20 to provide relief to SNFs on the timeframe requirements for Minimum Data Set
assessments and transmission.
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COVID-19 Emergency Declaration Blanket Waivers for SNFs and NFs
Staffing Data Submission
CMS is waiving 42 CFR 483.70(q) to provide relief to long-term care facilities on the requirements for
submitting staffing data through the Payroll-Based Journal system.
Waive Pre-Admission Screening and Annual Resident Review (PASARR)
CMS is waiving 42 CFR 483.20(k) allowing states and nursing homes to suspend these assessments for new
residents for 30 days. After 30 days, new patients admitted to nursing homes with a mental illness (MI) or
intellectual disability (ID) should receive the assessment as soon as resources become available.
Resident Groups
CMS is waiving the requirements at 42 CFR 483.10(f)(5), which ensures residents can participate in person in
resident groups. This waiver would only permit the facility to restrict in-person meetings during a national
emergency given the recommendations of social distancing and limiting gatherings of more than ten people.
Refraining from in-person gatherings will help prevent the spread of COVID-19.
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COVID-19 Emergency Declaration Blanket Waivers for SNFs and NFs
Training and Certification of Nurse Aides
CMS is waiving the requirements at 42 CFR 483.35(d) (with the exception of 42 CFR 483.35(d)(1)(i)), which
require that an SNF and NF may not employ anyone for longer than four months unless they met the training
and certification requirements under § 483.35(d). CMS is waiving these requirements to assist in potential
staffing shortages seen with the COVID-19 pandemic.
To ensure the health and safety of nursing home residents, CMS is not waiving 42 CFR § 483.35(d)(1)(i), which
requires facilities to not use any individual working as a nurse aide for more than four months, on a full-time
basis, unless that individual is competent to provide nursing and nursing-related services. We further note that
we are not waiving § 483.35(c), which requires facilities to ensure that nurse aides are able to demonstrate
competency in skills and techniques necessary to care for residents’ needs, as identified through resident
assessments and described in the plan of care.
Physician Visits in Skilled Nursing Facilities/Nursing Facilities
CMS is waiving the requirement in 42 CFR 483.30 for physicians and non-physician practitioners to perform
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COVID-19 Emergency Declaration Blanket Waivers for SNFs and NFs
in-person visits for nursing home residents and allow visits to be conducted, as appropriate, via telehealth
options.
Resident Roommates and Grouping
CMS is waiving the requirements in 42 CFR 483.10(e) (5), (6), and (7) solely for the purposes of grouping or
courting residents with respiratory illness symptoms and/or residents with a confirmed diagnosis of COVID-19,
and separating them from residents who are asymptomatic or tested negative for COVID-19. This action waives
a facility’s requirements, under 42 CFR 483.10, to provide for a resident to share a room with his or her
roommate of choice in certain circumstances, to provide notice and rationale for changing a resident’s room,
and to provide for a resident’s refusal a transfer to another room in the facility. This aligns with CDC guidance
to preferably place residents in locations designed to care for COVID-19 residents, to prevent the transmission
of COVID-19 to other residents.
In case of any confusion related to COVID-19 Emergency Declaration Blanket Waivers for SNFs and NFs, you can
take the assistance of Medical Billers and Coders (MBC). To know more about Skilled Nursing Facility (SNF)
Billing and Coding Services contact us at 888-357-3226/ info@medicalbillersandcoders.com.