The Episode of Care
The claim form is used to obtain payment. Carriers and other third parties will use the information on the claim form to gain information about the case.
Read MoreAuthor: Mario Fucinari DC, CCSP, APMP, MCS-P, CPCO
CMS Clarifies Qualified Medicare Beneficiary (QMB) Billing Requirements
Recently, the Centers for Medicare and Medicaid Services (CMS) once again clarified the Qualified Medicare Beneficiary (QMB) billing requirements.
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Medicare Releases Quality Payment Updates for 2019
On November 1, 2019, year 3 of the Medicare Quality Payment Program (QPP), key factors were released. Beginning in January 2019, the definition of eligible providers has been expanded to include physical therapists, occupational therapists, speech-language pathologists, audiologists, clinical psychologists, and registered dietitians or nutrition professionals.
Read MoreHow Do All of the Dates Work on the Claim Form?
How Do All of the Dates Work on the Claim Form? Marc and Dr. Mario Fucinari discuss the date requirements on the 1500 claim form.
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ICD-10 Changes Indicates the Need for Specificity
The latest changes in ICD-10 took effect last Monday, October 1, 2018. Unlike CPT and HCPCS codes, ICD-10 codes are updated on October 1 each year. Each year not only brings about code changes, but unfamiliarity with policy changes will leave you wondering as your reimbursements shrink.
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Avoid Duplication of Diagnoses
Although multiple segments or regions may be involved in the cause of a patient’s ailment, it is important to identify the main segment or region and report the diagnosis specifically. Medicare has recently reaffirmed that duplication of diagnoses in Box 21 on the claim form will be denied. Each area treated must have a unique diagnosis.
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Medicare Fees Increase (for some)
Congress passed the Bipartisan Budget Act of 2018 on 2/9/2018, changing the Medicare physician fee schedule and the processing of Medicare services. Section 50201 of this Act has made a change to the work Geographic Practice Cost Index (GPCI) floor, effective retroactive to 1/1/2018. Any area that previously was in an area with a work GPCI of less than 1.000 will be impacted.
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Medicare Requiring Modifier GP on Physical Therapy Services
On January 1, 2018, the Centers for Medicare and Medicaid Services (CMS) released MLN Matters Number: MM10176. In this notice, CMS identified certain services subject to the therapy cap. The revision became effective on January 1, 2018. Due to this revision, some providers have begun to receive claim rejections because they are not using the appropriate modifier.
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