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medical billing

CMS Updates for Telehealth billing

GT Modifier limited to CAH billing Previous guidance instructed providers to submit claims for telehealth services using the appropriate procedure code along with the telehealth modifier GT (via interactive audio and video telecommunications systems). In the Calendar Year (CY) 2017 Physician Fee Schedule (PFS) final rule, payment policies regarding Medicare’s use of a new Place of Service...

Medicare DMEPOS Requiring Prior Authorization

Beginning January 2017, certain DMEPOS items will require prior authorization from the Medicare Administrative Contractor. Prior authorization is a process through which a request for provisional affirmation of coverage is submitted to a medical review contractor for review before the item or service is furnished to the beneficiary and before the claim is submitted...

Medicare Social Security Number Removal Initiative

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019.  A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number on new Medicare cards for transactions like billing, eligibility status, and claim status....

Understanding Incident-to Billing

Incident-to Billing for Mid-level Providers The concept of incident-to billing is not new to the industry. Services and treatments are reimbursed at a tiered fee schedule depending on what level of healthcare professional billed for the service. If a physician bills for the service, it would be paid at 100 percent of the fee...