Medical groups and health systems that are members of the American Medical Group Association (AMGA) estimate that 60 percent of their Medicare revenues will be risk-based in 2019, pointing to a greater need for risk-assessment coders. Fierce Healthcare reports respondents to the organization’s annual risk survey said they expect revenues from Medicare Advantage to equal ...
In Billing
Dec 13th, 2017
In case you were unaware of proper billing of services for Medicare patients in a covered Part A inpatient stay, here is a refresher. Medicare will not pay acute-care hospitals for outpatient services provided to patients in a covered Part A inpatient stay at another facility. This includes Medicare patients who are inpatients of long-term ...
In Billing
Dec 11th, 2017
It’s essential for applicable providers to know how the definition of an attribution-eligible Medicare beneficiary for the Advanced Alternate Payment Model (APM) track of the Comprehensive Care for Joint Replacement (CJR) Model for the purposes of making Qualifying APM Participant determinations in the Quality Payment Program (QPP). In a fact sheet, posted Dec. 6 on ...
In Billing
Dec 8th, 2017
Effective Jan. 1, 2018, modifier GT Via interactive audio and video telecommunications systems is no longer required on professional claims for telehealth services. Place of Service (POS) code 02 certifies that the telehealth service meets Medicare’s requirements for reimbursement. Get Telehealth Services Paid in 2018 POS code 02, finalized in the 2017 Medicare Physician Fee Schedule (MPFS) f...
In Billing
Dec 5th, 2017
There’s usually a reason and a solution for every denied claim. Claim denials are inevitable. The first step to work through them is understanding the most common denials, such as: bundling; global denials; multiple frequency denials; and no plan coverage denials. Bundling Unbundling occurs when a service is billed using individual codes when a single, ...