When provider and payer work together, everyone wins. By Marcia A. Maar, COC, CPC, CRC Clean, accurate provider documentation improves reimbursement. To demonstrate, consider the ideal reimbursement process: A patient comes in for an office visit or service. A provider documents the reason for the visit, which proves medical necessity for services provided on the ...
In CMS
May 26th, 2017
Medicare Access and CHIP Reauthorization Act of 2015 will shake how providers are reimbursed to the core, as they are paid based on the quality of care versus the quantity of care through a fee-for-service model. How are providers and others in the industry going to cope with this new law, which was passed with bi-partisan ...
Coding these preventive procedures depends on the payer. For 2017, the American Medical Association (AMA) deleted CPT® 77051, 77052, 77055, 77056, and 77057, and introduced three replacement codes to report mammography: 77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral 77066 … bilateral 77067 Screening mammography, bilateral (2-view study of each brea...
In Billing
Jan 16th, 2017
The Medicare Access and CHIP Reauthorization Act (MACRA), enacted on April 16, 2015, extended Medicare administrative contractor (MAC) contract terms from five to 10 years. The legislation also requires the Centers for Medicare & Medicaid Services (CMS) to publish performance information on each MAC, to the extent that such information does not interfere with contract ...
Insurance payers can establish their own reimbursement policy. Know their coding rules. Question: Is there any recourse if a payer doesn’t honor CPT® coding guidelines? For instance, if the payer rejects a claim or won’t reverse a denial even if proper documentation is submitted, per CPT® requirements? Answer: This is a common issue, a common ...