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Showing posts from March, 2019

Advance Care Planning Billing

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It is common for hospitalists to have advance care planning discussions and address advance directives with patients (and families) during an admission for a serious life-threatening condition or end-stage chronic disease. Medicare waives the coinsurance and the Medicare Part B deductible for ACP when: ● Provided on the same day as a covered AWV ● Furnished by the same provider as a covered AWV ● Billed with modifier –33 (Preventive Services) Voluntary ACP is considered a preventive service when billed with the AWV on the same day by the same provider, so CMS waives the deductible and coinsurance for ACP. When AWV is medically necessary and billed with ACP, but the AWV is denied for exceeding the once-per-year limit, payment can still be made for the ACP. In that case, CMS applies the deductible and coinsurance to the ACP service. The deductible and coinsurance DOES apply when ACP is provided outside the covered AWV. NOTE: Critical Access Hospitals (CAHs) may bill for ...

Claims for Assistant-at-Surgery Services

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For assistant-at-surgery services performed by physicians , the fee schedule amount equals 16 percent of the amount otherwise applicable for the surgical payment. MACs may not pay assistants-at-surgery for surgical procedures in which a physician is used as an assistant at-surgery in fewer than five percent of the cases for that procedure nationally. This is determined through manual reviews. Procedures billed with the assistant-at-surgery physician modifiers “-80” (Assistant Surgeon), “-81” (Minimum assistant surgeon), “-82” (Assistant surgeon (when qualified resident surgeon not available)), or the AS modifier (physician assistants, nurse practitioners and clinical nurse specialists), are subject to the assistant-at surgery policy. Accordingly, Medicare pays claims for procedures with these modifiers only if the services of an assistant-at-surgery are authorized. Medicare’s policies on billing patients in excess of the Medicare allowed amount apply to assistant-at-surger...

Significance of Outsourcing Medical Billing Service in USA

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It is safe to say that you are a doctor with your own training and you are asking why you should consider exploiting medical billing outsourcing? Each doctor who runs their very own medical practice comprehends that running a medical practice is like maintaining some other business in more ways than one. While doctors center around dealing with their patients before some other need, it is as yet imperative to concentrate on producing income to keep the work on running. That implies ensuring that billing and coding are handled appropriately; however, this can be a challenge for doctors, especially when they invest the vast majority of their time taking care of their patients. Hence, it is vital for doctors to consider outsourcing their medical billing services in USA to a professional company. What is Medical Billing ? Medical billing is the way toward submitting and following up on claims with health insurance companies so as to get payment for ser...