Billing Medicare Secondary Payor ClaimsBilling Medicare Secondary Payor ClaimsMedicare Secondary Payor forms can be filled out at the time of service in the case that Medicare doesn't have the SCD Secondary Claim Development Questionnaire form. Learn to get paid when Medicare doesn't have one on file Articles
Are you getting deleted claims from Medicare?
2007-10-06 21:52:00 Most states are now starting to "delete" Medicare claims at the EDI level for invalid NPI crosswalks. It is extremely important to read your Carrier Forwarded Reports from Medicare to identify if your office is having these issues.Medicare can delete your claims for the following reasons:* Billing Provider level (2010AA) - M340 & M379* Pay to Provider level (2010AB) - M341 & M380* Rendering Provider level (2310B) - M343 & M381* Rendering Provider level (2420A) - M347 & M382Edits M340, M341, M343, and M347 occur when the NPI submitted with legacy number does not match the crosswalk; that is the NPI legacy is not on the crosswalk or is invalid. Edits M379, M380, M381, and M382 will fail if you are sending NPI only and the NPI is not on the crosswalk or you are sending an EIN/SSN with the incorrect qualifier.This is not a software vendor issue but if you need help with setting up your carrier correctly you may contact your practice management software support department... More About: Claims
How to bill for referring providers that do not have a NPI number?
2007-10-06 20:28:00 If you find referring providers that are no longer accepting Medicare or are becoming Cash Pay only offices you can still bill with the referring provider information if you have that referring providers Legacy (UPIN) number.Medicare is still accepting up to May 23 2008 the use of Legacy numbers on referring providers. It will become at some point mandatory for all physicians to register and maintain a NPI (national provider indicator) number. Physician's who have decided that they do not want to become participating providers with Medicare will still be required to register for a NPI #. It's free and it will become mandatory so it's best to do it soon. For additional Medicare documentation on this subject you can reference CR 5529. More About: Bill , Refer , Ovid , Number
Can a provider register for a NPI number without having a license?
2007-10-06 20:20:00 In order for a physician to apply for a National Provider Identifier # the physician will need to have a license to practice in one of the states. If the provider does not have a license they will not be able to apply for a NPI#.To check for a provider or referring providers NPI# please visit:https://nppes.cms.hhs.gov/NPPES/NPI Regis trySearch.do?subAction=reset&sea rchType=ind More About: Register , License , Ovid
Medicare Secondary claims to be submitted electronically
2007-10-06 19:18:00 Medicare Secondary Payor claims must be submitted electronically to Medicare unless your office fits the following exceptions:*Small Provider with 9 or fewer full time employees* Roster billing of mass immunizations covered by Medicare* Claims for payment under Medicare demonstration projects when information is required that cannot be submitted electronically* Claims where Medicare is the tertiary payer to two (or more) primary payers; e.g., Medicare is the third payer (not to be confused with claims where Medicare is the secondary payer)* Dental claims to Medicare.Remember when submitting claims electronically to Medicare or other insurance carriers your office will need to be well versed on Medicare claim adjustment Reason Codes.I would suggest that you visit one of my other blogs that details these steps in full:http://askamedicalbiller.blogspot.co m/2007/07/claim-adjustment-reason-codes-a nd.htmlIf your office has any questions on MSP codes please post a log and I would be happy ... More About: Medicare , Mitt , Mitte , Ally
Remittance Advice Remark Codes crosswalk
2007-10-06 18:58:00 If your office is receiving Medicare electronic explanations of benefits (EOB's) you may need to identify the meanings to specific Remi ttance Advice Remark Codes . Copy the website and paste it in the google toolbar above: wpc-edi.com/codes/remittanceadvice(this will pull the website up in a seperate window so you can follow the following steps) 1. Down arrow and select Currently Valid Codes2. Review the codes you are in need of a few samples are:M1 - X-ray not taken within the past 12 months or near enough to the start of treatment.M2 - Not paid separately when the patient is an inpatient.M3 - Equipment is the same or similar to equipment already being used.M4 - Alert: This is the last monthly installment payment for this durable medical equipment.Note: (Modified 4/1/07)M5 - Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed.M6 - Alert: You must furnish and service this item for a... More About: Mitt , Odes
How to validate Referring Provider National Provider Indicator (NPI#)
2007-10-06 18:38:00 The National Plan & Provider Enumeration System has recently released a website for medical practices to use to verify provider's NPI#. This website is extremely easy to use and will help medical offices identify providers NPI#'s without having to call the doctor directly.1. Pull up this website: https://nppes.cms.hhs.gov/NPPES/NPIRegist rySearch.do?subAction=reset&searchTyp e=ind2. Enter in the providers or referring providers NPI# *You can choose to enter in the following information3. Provider First Name4. Provider Last Name5. Practice Address City6. Practice Address State7. Practice Address Zip CodeClick Search and you will receive the following information:Organization InformationAuthorized Official Information (office contact information)NPI Information: Provider Business Mailing Address including phone and fax #Provider Business Practice Location Address including phone and fax #Organization Taxonomy: What taxonomy #'s to use when billing claimsOther Provider Identif... More About: Indicator , Refer , Indica
How to Validate your medical providers NPI numbers
2007-10-06 18:21:00 Copy the following link and add it to the above Google Search to pull up this website in a new window: barrydebruin.com/php.npi/ to validate your medical providers National Provider Identifier (NPI) number. This is also helpful to validate Referring Provider NPI#'s.If for any reason you do not have access to the internet and you need to validate the NPI# manually you can follow the following steps:NPI #'s are generated using the Luhn formula so that the final digit can be derived by performing mathematical operations on the first 9. NPI Check Digit Calculation: The NPI # format consists of ten digits (9 numerics followed by 1 numeric check digit). The National Provider Identifier check digit is calculated using the Luhn formula. Example of Check Digit Calculation for NPI: Assume the 9-position identifier part of the NPI# is 123456789. Using the Luhn formula on the identifier portion, the check digit is calculated as shown below. NPI # without the check digit: 1 2 3 4 5 6 7 8 9 Ste... More About: Medical , Numbers , Ovid , Vali , Number
Ordering the Correct CMS 1500 version
2007-08-14 05:45:00 I will just start by saying always bill Medicare electronically (even secondary claims) if at all possible and then you won't run into this issue:Back in 2006 Medicare released the first version of CMS 1500 forms (12-90) and recently came out with a newer version of CMS 1500 forms (08-05). On January 1st CMS began accepting the new CMS 1500 forms (08-05) with a planned cut off date of the old forms scheduled for April 1st 2007. CMS then identified formatting issues with the new CMS 1500 forms (08-05) but decided that as of July 2nd 2007 they were still no longer going to accept CMS 1500 (12-90) forms. Claims were being sent back as of July 2nd when received on this old CMS - 1500 format. However; Medicare has identified that since July 2nd the GPO Government Printing Office was not able to accept and fill orders (they actually create CMS 1500 08/05 forms for use) for the revised form so they recommend buying these CMS 1500 (08/05) forms from other vendors and not directly from Medi... More About: Version , Erin , Rect
Group practices need NPI numbers
2007-08-14 05:39:00 In order for group practices to bill Medicare electronically they will need a group NPI number. They are required to obtain and use these group NPI numbers to identify themselves as a Billing and Pay-to providers in Medicare claims.Medicare also requires rendering providers by identified by NPI number on the claims whether or not these rendering providers are covered providers. Group Practices that are enrolled in Medicare will want to ensure that their members (physician or other practitioners) obtain NPI numbers in order to receive payments for the group practice by Medicare.Office's can have a Facility NPI, Group NPI and individual provider NPI. Verify with Medicare all numbers as they are different. More About: Numbers , Number
McKesson services
2007-08-14 05:30:00 I thought I would spend a quick second to tell you about my experience with McKesson Clearinghouse. They are a great clearinghouse that has friendly customer service. My medical billing/practice management software is interfaced with them so I don't get to talk to them much but my cases are resolved if not immediately usually under 72 hours.I submit CMS-1500, HCFA-1500 & 837 files daily to them and they have so many great reports that help me identify the status of my claims within 24 hours. Also, they send me carrier forwarded reports that give me insight to accepted claims from my insurance carriers within days of submission.If you are looking for a clearinghouse you may want to look at McKesson. Also, McKesson has purchasing power. In January of 2007 they bought Per-Se Technologies which owns Medisoft and Lytech (I do not use these medical billing software products) and later in the year they bought a hospital front end software. As McKesson stays up with new technologies we... More About: Services
Medicare NPI numbers and Clearinghouses
2007-08-14 05:19:00 Medicare has identified that some clearinghouses are stripping NPI numbers when forwarding the claims on to Medicare. This of course has a huge consequence to the providers including a false sense of security that your claims are actually going to the carrier correctly and without the NPI these claims will not count towards PQRI participation for eligible professionals (losing your Bonus potential).If you are using ERA (electronic remittance advice) through your clearinghouse don't be fooled just because you see the NPI number on the ERA form. They have also identified that clearinghouses are "adding" these to the ERA even if the claim wasn't transmitted with them.Medicare of course can not tell you "which" clearinghouses are doing this so they recommend you call your clearinghouse and ask them. Of coure, are clearinghouses going to actually tell us the truth????Well, for those who may care I use McKesson and I am getting my Medicare payments with using my NPI number on my claims.... More About: Numbers , Medicare , Ouse , Clearing , Number
National Plan & Provider Enumeration System
2007-08-14 05:07:00 Coming in early September medical billing offices will be able to identify NPI numbers for referring providers. Currently the website that will be storing these are located at:https://nppes.cms.hhs.gov/NPPES/NPIReg istryHome.doAlthough they are not viewable yet, I can't wait to be able to search for these. It will cut my office staff time down from not having to call the referring providers.Thank you Medicare! More About: National , System , Plan , Provider , ENUM
NPI Registry
2007-08-14 04:54:00 For those who are still trying to figure out how to get NPI numbers for referring providers Medicare is working on a solution which should be available around September 4th 2007.NPPES National Plan and Provider Enumeration System is taking these next couple of months to ensure that all providers information is correct prior to placing it on the web. If you are a medical health care provider you will need to submit any possible edits by Monday, August 20, 2007.This following outline was taken from Medicare's Data Dissemination files:Health care medical providers can refer to, "Information on FOIA-Disclosable Data Elements in NPPES," dated June 20, 2007 (http://www.cms.hhs.gov/NationalProvIdent Stand/Downloads/NPPES_FOIA_Data%20Element s_062007.pdf ) for assistance in making their edits. Some of the key data elements that are FOIA-Disclosable are:NPIEntity Type Code (1-Individual or 2-Organization)Replacement NPIProvider Name (First Name, Middle Name, Last Name, Prefix, Suffix, Credent... More About: Registry , Regis
Searching for a Medical Billing Software?
2007-07-08 01:36:00 Medical Billing Software searches just take up too much time for most people. Who wants ot give out their personal information just to spend 5 minutes trying to figure out if the software is even what you are looking for.Well, I found a website that does a lot of the research for you. Identify if a software is Web-based or server based, what services they offer and some even list their prices. Save time and money by visiting http://medicalbillingsoftwarepro.com/.The feature I like the most is if you scroll down to the bottom they ask people to leave comments about that software. So, if you are currently using a software or are looking to see what other clients have said go visit this website now. More About: Medical , Searching , Al B
Claim Adjustment Reason Codes and Remittance Advice Remark Codes
2007-07-08 00:50:00 Medicare came up with a simpler way to bill secondary claims so that all insurance carriers can handle electronic claims without a paper EOB. In reality it is great to not have to print the primary EOB, Secondary claim and snail mail this to the carrier anymore but learning something new has become quite complex. My medical billing software came out with a nifty release so that my medical billers can handle attaching claim adjustment reason codes and remittance advice remark codes however; they didn't stress the importance of doing it correctly and well my billers did their best but came up short. So a few months later and many secondary claim rejections I have identified that it would be best to research for myself why those my billers post are getting rejections while my electronic remittance advice (ERA) are getting paid out on. Currently I get my EOB's electronically for my top 10+ insurance carriers and I can review and approve the payments. My EOB also is archivable so I nev... More About: Advice , Reason , Vice , Adjust , Mitt
Do patients have to give Social Security Numbers to Medical Providers?
2007-07-08 00:29:00 It was a sunny Saturday morning and in comes our last patient of the day. The office was cleared out and I thought this was going to be a quick in and out patient. I handed the patient his "new" patient registration forms and went back to my desk hoping to complete my confirmation phone calls so I could leave the office on time.A few minutes later the patient came to my desk and gave me the completed patient registration form. I quickly scanned through it and saw that the social security number was missing. Sir, can I get your Social Security Number. He explained politely that he does not give it out. I let the patient know that I appreciated his reasons for not wanting to supply this # but explained that the provider has policies to not treat patients without the social security number.I went to the doctor and notified him of the situation. The next hour I went back and forth between the doctor and the patient explaining each others side. Finally, the doctor came from his room and ... More About: Medical , Social Security , Numbers
Can Providers bill for Missed or No Show Visits?
2007-07-07 23:36:00 A client wrote me last week the following scenario: 8:00 am and all is quiet. A quick glance at the schedule let's me know that I am going to have a busy day so I need to enjoy this brief moment before things pick up. I have over 20 patients scheduled and 1 doctor to treat them all.The middle of the day and things are going well. I look at the schedule and we have treated 10 patients so far. 1/2 done YEAH our next patient is a sweet elderly woman who started getting treated a few months ago. She is usually a few minutes early but today it appears she is really behind putting me behind schedule. I call the patient and identify that she hasn't even left her home but completely forgot about her appointment . We rescheduled her appointment but now I am in a dilemma. Can I bill her for this visit as a No Show ? She is a Medicare patient but can we bill Medicare patients for No Shows? We charge $35.00 for our other patients who do not cancel within 24 hours. The answer is YESMedicare has... More About: Bill , Provider , Ovid
Claim Adjustment Reason Codes and Remittance Advice Remark Codes
2007-07-07 23:28:00 HIPAA of 1996 instructs health plans to be able to conduct standard electronic transactions (submission of claims, claims inquiries, electronic remittance advice, etc.) adopted under HIPAA using valid standard codes.Read this entire article at to learn more:http://www.cms.hhs.gov/MLNMattersArt icles/downloads/MM5634.pdf More About: Advice , Reason , Vice , Adjust , Mitt
How to use Place of Service on a medical billing claim
2007-06-17 04:44:00 For new billers who are starting to learn the medical lingo you may find a great benefit from this Free Medicare training video. Learn how to get claims paid correctly when using the correct Place of Service (POS) codes. This Free Medicare tutorial will take at least 30 minutes to review.http://www.wpsmedicare.com/provide r/tutorials.shtml More About: Medical , Billing , Vice
Wisconsin Physician Service Website change
2007-06-17 04:38:00 Prepare now for the changes coming to Wisconsin Physician Service website. They will soon be changing their website from http://www.wpsic.com/medicare to http://www.wpsmedicare.com/.To save this new link as a favorite follow these steps:1. Click on the new link http://www.wpsmedicare.com/2. Click Control + D3. Give it a short name like WPS4. Create in: folder or Link option5. Click AddDelete the old website address from your favorites list More About: Website , Change , Vice
Computer Based Training
2007-06-17 04:32:00 Medicare is offering a easy to use Computer based tutorial on how to get claims paid out on. All offices that bill claims to Medicare should take 30 minutes to go through the tutorial. It explains denial reasons and has references to cross-walks.If your office is getting a lot of denial codes such as CO16, CO4, COB18, and PR16 this training will be very informative.Do not delay check it out now:http://www.wpsmedicare.com/provider/u nprocessable_claims_files/frame.html More About: Training , Base , TRAI , Raining
Provider Transaction Account Number (PTAN)
2007-06-17 04:30:00 Medicare Tip of the week -Provider Tran saction Account Number (PTAN) is what the Provider Identification Number (PIN) will be called after May 23, 2007. Providers will continue to receive a PTAN (PIN) and can be required to use it in certain transactions or contacts. Currently, both terms might be used, but be aware that both terms refer to the same number. More About: Count , Ovid
Designated National Provider Identifier Medicare website
2007-06-17 04:19:00 Medicare has officially moved all NPI documentation to one main website for reference. All doctors are still required to register for a NPI.http://www.wpsmedicare.com/provider/n pi_medicare.shtml More About: Website , National , Medicare , Provider , Nate
Electronic Medicare Secondary Payer (MSP) Submitters
2007-06-17 04:11:00 Did you know that after a primary insurance carrier has processed your claim the office "must" include claim adjustment reason codes (CARC) when sending it to Medicare for processing?As of June 1st you will no longer see code 42 being used:Code 42: "Charges exceed our fee schedule or maximum allowable amount"This code has been replaced with code 45:code 45: "Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement."If you have not been using Code 45 since June 1st your claims maybe getting rejected by Medicare.CARC codes are updated 3x's a year and can be viewed at: http://www.wpc-edi.com/custom_html/claima djustment.htmPlease take a few minutes to review this website for additional information. More About: Electronic , Tron , Econ , Submitters
Physician Quality Reporting Initiative (PQRI) FAQ
2007-06-16 23:22:00 July 1st is around the corner and are you ready to begin billing the PQRI for the 1.5% incentive payout? For more information go here:http://www.cms.hhs.gov/PQRI/35_2008P QRIInformation.asp More About: Medicare , Initiative , Quality , Physician , Ality
Free Medicare Web-based training Courses
2007-06-16 23:14:00 CMS offers over 18 hours of web based courses that are very informative and FREE!For a complete listing of courses, you can visit CMS's website at:http://cms.meridianksi.com/kc/main/k.. .t=kc0001&loc=1 Or for additional medical billing software training you can visit: www.trainingmedical.com. This website offers Microsoft Word, and specific medical billing software training videos. Click on the links to view the Video Library. More About: Training , Free , Medicare , Base , TRAI
Medicare Coverage for Smoking Cessation
2007-06-16 22:52:00 Did you know Medicare will cover smoking cessation counseling for patients with certain conditions that are adversely affected by smoking?G0375 - Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes.G0376 - Smoking and tobacco-use cessation visit; intensive, greater than 10 minutes.Diagnosis Codes should reflect the condition the patient has that is adversly affected by the use of tobacco or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco.E&M codes can be billed on the same day as Smoking cessation visits please add modifier 25 to procedure codes 99201 - 99215.To find out more about billing for smoking cessation counseling, visit the follow link to CMS's webpage:http://www.cms.hhs.gov/SmokingCes sation/http://www.cms.hhs.gov/MLNMattersA rticles/downloads/MM4104.pdfhttp://www.cm s.hhs.gov/ContractorLearningResources/dow nloads/JA3834.pdfThe following PDF pamphle... More About: Coverage
Register Now for the Medicare 2007 Bonus
2007-03-24 17:15:00 Doctors if you haven't heard about this already now is the time to register for the first conference call on how to identify if you will be eligible for the 1.5% bonus payment of all charges posted during July 1st - December 31, 2007.Eligbile Professionals are:Under PQRI, covered professional services are those paid based on the Medicare Physician Fee Schedule. To the extent eligible professionals are providing services which get paid under the Medicare Physician Fee Schedule, those services are eligible for PQRI.TRHCA section 101 defines "eligible professional" as the following:Medicare physician, as defined in Social Security Act (SSA) section 1861(r)Doctor of MedicineDoctor of OsteopathyDoctor of Podiatric MedicineDoctor of OptometryDoctor of Oral SurgeryDoctor of Dental MedicineChiropractorPractitioners described in SSA section 1842(b)(18)(C)Physician AssistantNurse PractitionerClinical Nurse SpecialistCertified Regis ter ed Nurse AnesthetistCertified Nurse MidwifeClinical Social... More About: Care , Bonus
How to find a Taxonomy Code
2007-03-24 17:08:00 Have you ever wondered where to find a Tax onomy code? Follow these instructions:1. Click on http://www.wpc-edi.com/codes/Code s.asp2. Click on Health Care Provider Taxonomy Code Set under HIPAA-Related Code Lists3. Click on the + sign if your provider is a Non-Individual or Individual/Groups4. Search through the sections by clicking on the + More About: How To , Find
Medicare to give BONUS to providers
More articles from this author:2007-03-21 03:05:00 You can thank the president:In December of 2006 a Tax Relief & Health Care Act of 2006 (TRHCA) was signed by the president. This new Physician quality reporting system allows doctors to volunteer to be included for this incentive bonus.If Medicare identifies you have successfully reported designated set of quality measures on claims dated from July 1st - December 31 of 2007 YOU may be eligible for a bonus payment...To learn more visit: http://www.cms.hhs.gov/pqri/ More About: Bonus , Give , Provider 1, 2, 3 |
 |
|
 |
