Rural Health Clinic (RHC) Qualifying Visit List ( )
|
|
|
- Brent Bates
- 6 years ago
- Views:
Transcription
1 Rural Health Clinic (RHC) Qualifying Visit List ( ) The RHC Qualifying Visit List is updated to include additional medically-necessary billable visits, effective April 1, 2016, but not payable until October 1, RHCs should hold claims for these billable visits added to the RHC Qualifying Visit List until October 1, when RHCs can bill these claims for payment. Beginning on April 1, 2016, RHCs are required to report the appropriate HCPCS (Healthcare Common Procedure Coding System) code for each service line along with revenue code on their Medicare claims. Services furnished through March 31, 2016, should be billed without a HCPCS code under the previous guidelines. RHC Visits An RHC visit is defined as a medically necessary medical or mental health visit, or a qualified preventive health visit. The visit must be a face-to-face (one-on-one) encounter between the patient and an RHC practitioner during which time one or more RHC services are furnished. A Transitional Care Management service can also be an RHC visit. Qualified preventive health services include the IPPE, the AWV, and other Medicare covered preventive services recommended by the USPSTF with a grade of A or B. For a complete list of preventive services and their coinsurance and deductible requirements, see the RHC Preventive Services Chart on the CMS RHC center webpage. To qualify for Medicare payment, all the coverage requirements for a RHC visit must be met. A RHC visit must be furnished in accordance with the applicable regulations at 42 CFR Part 405 Subpart X, including 42 CFR that describes what constitutes a visit. For additional information on RHC policies and requirements, see the Medicare Benefit Policy Manual, Chapter 13. Qualifying Visits A RHC visit must include one of the services listed on the RHC Qualifying Visit List, which is shown below. Updates to the qualifying visit list are made on a quarterly basis, if needed, and posted on the CMS RHC center webpage. RHCs can subscribe to the center page for updates. The total charges for the encounter must be included on the qualifying visit line, minus any charge for an approved preventive service. Payment and applicable coinsurance and/or deductible shall be based upon the qualifying visit line. All other RHC services furnished during the encounter are also reported with a charge. 1
2 Medical Services HCPCS Code Short Descriptor Acne surgery Drainage of skin abscess Drainage of skin abscess Drainage of pilonidal cyst Drainage of pilonidal cyst Remove foreign body Remove foreign body Drainage of hematoma/fluid Puncture drainage of lesion Debride infected skin Debride skin at fx site Debride skin musc at fx site Deb subq tissue 20 sq cm/< Trim skin lesion Trim skin lesions 2 to Trim skin lesions over Biopsy skin lesion Removal of skin tags <w/ Shave skin lesion 0.5 cm/< Shave skin lesion cm Shave skin lesion cm Shave skin lesion >2.0 cm Shave skin lesion 0.5 cm/< Shave skin lesion cm Shave skin lesion cm Shave skin lesion >2.0 cm Shave skin lesion 0.5 cm/< Shave skin lesion cm Shave skin lesion cm Shave skin lesion >2.0 cm Exc tr-ext b9+marg 0.5 cm< Exc tr-ext b9+marg cm Exc tr-ext b9+marg cm Exc tr-ext b9+marg 2.1-3cm/< Exc tr-ext b9+marg cm Exc tr-ext b9+marg >4.0 cm Exc h-f-nk-sp b9+marg 0.5/< Exc h-f-nk-sp b9+marg
3 Exc h-f-nk-sp b9+marg Exc h-f-nk-sp b9+marg Exc h-f-nk-sp b9+marg Exc h-f-nk-sp b9+marg >4 cm Exc face-mm b9+marg 0.5 cm/< Exc face-mm b9+marg cm Exc face-mm b9+marg cm Exc face-mm b9+marg cm Exc face-mm b9+marg cm Exc face-mm b9+marg >4 cm Removal sweat gland lesion Exc tr-ext mal+marg 0.5 cm/< Exc tr-ext mal+marg cm Exc tr-ext mal+marg cm Exc tr-ext mal+marg cm Exc tr-ext mal+marg cm Exc tr-ext mal+marg >4 cm Exc h-f-nk-sp mal+marg 0.5/< Exc s/n/h/f/g mal+mrg Exc s/n/h/f/g mal+mrg Exc s/n/h/f/g mal+mrg Exc s/n/h/f/g mal+mrg Exc s/n/h/f/g mal+mrg >4 cm Exc f/e/e/n/l mal+mrg 0.5cm< Exc f/e/e/n/l mal+mrg Exc f/e/e/n/l mal+mrg Exc f/e/e/n/l mal+mrg Exc f/e/e/n/l mal+mrg Exc f/e/e/n/l mal+mrg >4 cm Trim nail(s) any number Debride nail Debride nail 6 or more Removal of nail plate Drain blood from under nail Removal of nail bed Remove nail bed/tip Biopsy nail unit Repair of nail bed Reconstruction of nail bed Excision of nail fold toe 3
4 Rpr s/n/ax/gen/trnk 2.5cm/< Rpr s/n/ax/gen/trnk cm Rpr s/n/ax/gen/trk cm Rpr s/n/a/gen/trk cm Rpr s/n/a/gen/trk cm Rpr s/n/ax/gen/trnk >30.0 cm Rpr f/e/e/n/l/m 2.5 cm/< Rpr f/e/e/n/l/m cm Rpr f/e/e/n/l/m cm Rpr f/e/e/n/l/m cm Rpr fe/e/en/l/m cm Rpr fe/e/en/l/m cm Rpr f/e/e/n/l/m >30.0 cm Closure of split wound Closure of split wound Intmd rpr s/a/t/ext 2.5 cm/< Intmd rpr s/a/t/ext Intmd rpr s/tr/ext Intmd rpr s/a/t/ext Intmd rpr s/a/t/ext Intmd rpr s/tr/ext >30.0 cm Intmd rpr n-hf/genit 2.5cm/< Intmd rpr n-hf/genit Intmd rpr n-hf/genit Intmd rpr n-hf/genit Intmd rpr n-hf/genit Intmd rpr n-hf/genit >30.0cm Intmd rpr face/mm 2.5 cm/< Intmd rpr face/mm cm Intmd rpr face/mm cm Intmd rpr face/mm cm Intmd rpr face/mm cm Intmd rpr face/mm Intmd rpr face/mm >30.0 cm Destruct premalg lesion Destruct premalg les Destroy premal lesions 15/> Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions 4
5 Destruct b9 lesion Destruct lesion 15 or more Chemical cautery tissue Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Destruction of skin lesions Injection of sinus tract Inject sinus tract for x-ray Removal of foreign body Removal of foreign body Ther injection carp tunnel Inj dupuytren cord w/enzyme Inj tendon sheath/ligament Inj tendon origin/insertion Inj trigger point 1/2 muscl Inject trigger points 3/> Drain/inj joint/bursa w/o us Drain/inj joint/bursa w/us Drain/inj joint/bursa w/o us Drain/inj joint/bursa w/us Drain/inj joint/bursa w/o us Drain/inj joint/bursa w/us Aspirate/inj ganglion cyst Treatment of bone cyst Eye exam new patient 5
6 92004 Eye exam new patient Eye exam establish patient Eye exam&tx estab pt 1/>vst Rmvl devital tis 20 cm/< Wound(s) care non-selective Chiropract manj 1-2 regions Chiropract manj 3-4 regions Chiropractic manj 5 regions Office/outpatient visit new Office/outpatient visit new Office/outpatient visit new Office/outpatient visit new Office/outpatient visit new Office/outpatient visit est Office/outpatient visit est Office/outpatient visit est Office/outpatient visit est Nursing facility care init Nursing facility care init Nursing facility care init Nursing fac care subseq Nursing fac care subseq Nursing fac care subseq Nursing fac care subseq Nursing fac discharge day Nursing fac discharge day Annual nursing fac assessmnt Domicil/r-home visit new pat Domicil/r-home visit new pat Domicil/r-home visit new pat Domicil/r-home visit new pat Domicil/r-home visit new pat Domicil/r-home visit est pat Domicil/r-home visit est pat Domicil/r-home visit est pat Domicil/r-home visit est pat Home visit new patient Home visit new patient Home visit new patient Home visit new patient 6
7 99345 Home visit new patient Home visit est patient Home visit est patient Home visit est patient Home visit est patient Trans care mgmt 14 day disch Trans care mgmt 7 day disch Advncd care plan 30 min 1 This billable visit is effective on April 1, 2016, but will receive payment beginning on October 1, Approved Preventive Health Services HCPCS Code Short Descriptor G0101 Ca screen; pelvic/breast exam G0102* Prostate ca screening; dre G0117* Glaucoma scrn hgh risk direc G0118* Glaucoma scrn hgh risk direc G0296 Visit to determ LDCT elig G0402 Initial preventive exam G0436 Tobacco-use counsel 3-10 min G0437 Tobacco-use counsel >10 G0438 Ppps, initial visit G0439 Ppps, subseq visit G0442 Annual alcohol screen 15 min G0443 Brief alcohol misuse counsel G0444 Depression screen annual G0445 High inten beh couns std 30 min G0446 Intens behave ther cardio dx G0447 Behavior counsel obesity 15 min Q0091 Obtaining screen pap smear *Coinsurance and deductible are not waived Mental Health Services HCPCS Code Short Descriptor Psych diagnostic evaluation Psych diag eval w/med srvcs Psytx pt&/family 30 minutes Psytx pt&/family 45 minutes 7
8 90837 Psytx pt&/family 60 minutes Psytx crisis initial 60 min Psychoanalysis Effective January 1, 2016 CPT code (chronic care management) is paid based on the Medicare Physician Fee Schedule (MPFS) national average non-facility payment rate when CPT code is billed alone or with other payable services on a RHC claim. 8
Rural Health Clinic Qualifying Visit List (RHC QVL) ( )
Rural Health Clinic Qualifying Visit List (RHC QVL) (4-27-16) The RHC QVL is intended as guidance for RHCs beginning to report HCPCS codes. It consists of frequently reported HCPCS codes that qualify as
2016 RVU Revenue Impact Report for Podiatry
Guerrilla Podiatry: Revenue Impact Report RVU Revenue Impact Report for Podiatry by Pamela Thompson All RIGHTS RESERVED Contact: pamthompson@guerrillapodiatry.com Copyright Pamela Thompson. ALL RIGHTS
Medicaid vs. Medicare Facility. Nevada Medicaid Rates (1) Medicare Non-Facility. Medicare Facility Rates (2) Procedur
230-12 Division of Health Care Financing & Policy SB 278 Section 16 - Physician Rates Reporting Medicaid 2012 Physician Rates vs. Medicare 2012 Physician Rate Comparison Facility & Non-Facility Rate
MEMORANDUM. TO: Dermatology Providers FROM: Community Health Center Network SUBJECT: Dermatology Prior Authorization Requirements DATE: May 12, 2017
MEMORANDUM TO: Dermatology Providers FROM: Community Health Center Network SUBJECT: Dermatology Prior Authorization Requirements DATE: May 12, 2017 Please read this important notice regarding prior authorization
Customized Fee Analyzer. Fee information for your area. Sample page. Power up your coding optum360coding.com
2019 Customized Fee Analyzer Fee information for your area Power up your coding optum360coding.com Contents Introduction...1 Using the Analyzer...7 Analyzer Worksheets...13 Professional & Technical Splits
Counseling to Prevent Tobacco Use
News Flash Vaccination is the Best Protection Against the Flu. This year, the Centers for Disease Control and Prevention (CDC) is encouraging everyone 6 months of age and older to get vaccinated against
MEDICAL POLICY: Telehealth Services
POLICY: PG0142 ORIGINAL EFFECTIVE: 01/01/08 LAST REVIEW: 12/12/17 MEDICAL POLICY: Telehealth Services GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated
Physician Services. Effective 7/1/2016-6/30/2017
Physician Services 00100 ANESTH SALIVARY GLAND $42.90 00400 ANESTH SKIN EXT/PER/ATRUNK $42.90 00102 ANESTH REPAIR OF CLEFT LIP $42.90 00402 ANESTH SURGERY OF BREAST $42.90 00103 ANESTH BLEPHAROPLASTY $42.90
Agenda. Medicare G codes Initial Preventive Physical Examination (IPPE) Annual Wellness Visit (AWV) Preventive Services
Medicare G Codes Agenda Medicare G codes Initial Preventive Physical Examination (IPPE) Annual Wellness Visit (AWV) Preventive Services Initial Preventative Physical Examination (IPPE) Components of the
Cost and Quality Information for Health Care Consumers Required by 2009 Wisconsin Act 146
Cost and Quality Information for Health Care Consumers Required by 2009 Wisconsin Act 146 Page 1 of 6 2009 Wisconsin Act 146 seeks to make health care costs and charges clearer to consumers. It requires
Page 1 RELEASED 7/2/18
Page 1 00100 ANESTH SALIVARY GLAND N 00104 ANESTH ELECTROSHOCK N 00120 ANESTH EAR SURGERY N 00124 ANESTH EAR EXAM N 00126 ANESTH TYMPANOTOMY N 00140 ANESTH PROCEDURES ON EYE N 00142 ANESTH LENS SURGERY
Codes on the Ambulatory Surgery Services fee schedules
Procedure Code SHORT DESCRIPTION 10021 FNA W/O IMAGE 10022 FNA W/IMAGE 10030 GUIDE CATHET FLUID DRAINAGE 10035 PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE 10036 PERQ SFT TISS LOC DEVICE PLMT ADD LES
Certified Community Behavioral Health Clinic Demonstration Grant WRAP Supplemental Payment Reference Guide
Certified Community Behavioral Health Clinic Demonstration Grant WRAP Supplemental Payment Reference Guide (Effective June 2017) Table of Contents WRAP Supplemental Payment Process Overview... 1 WRAP Supplemental
ASC Payment Indicators January 2014
ASC Payment Indicators January 2014 10021 Fna w/o image P2 10022 Fna w/image G2 10030 Guide cathet fluid drainage P2 10040 Acne surgery P2 10060 Drainage of skin abscess P3 10061 Drainage of skin abscess
Medicare Medicare Annual Well Visits. CHUG October 23, 2011
Medicare 2011 Medicare Annual Well Visits CHUG October 23, 2011 Background/Disclaimers 60 % of my clinical work is Geriatrics 40% Medical Informatics No conflict of interests I do not work for CMS Agenda
3. The prescribed fee shall be accepted as payment in full for the podiatry services.
WorkSafeBC Schedule for Podiatry Services 1. The Payment Schedule includes the services of podiatrists who are registered members in good standing of the College of Podiatric Surgeons of British Columbia,
A PROVIDER S GUIDE TO PREVENTIVE HEALTH SERVICES FOR YOUR PATIENTS
ConnectiCare, together with the Centers for Medicare & Medicaid Services, encourages the use of preventive health services. For certain basic preventive health services, ConnectiCare Medicare Plan beneficiaries
CHAP3-CPTcodes _ final.doc Revision Date: 1/1/2012
CHAP3-CPTcodes10000-19999_01012012final.doc Revision Date: 1/1/2012 CHAPTER III SURGERY: INTEGUMENTARY SYSTEM CPT CODES 10000-19999 FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES
32 CFR (a)(4), (a)(6)(iii), and (a)(6)(iv)
CHAPTER 15 SECTION 1 ISSUE DATE: November 6, 2007 AUTHORITY: 32 CFR 199.14(a)(4), (a)(6)(iii), and (a)(6)(iv) I. APPLICABILITY This policy is mandatory for the reimbursement of services provided either
LOUISIANA MEDICAID PROGRAM ISSUED: 02/01/12 REPLACED: 02/01/94 CHAPTER 5: PROFESSIONAL SERVICES SECTION 5.1: COVERED SERVICES PAGE(S) 5
Immunizations Vaccine Codes Providers should refer to the Immunization Fee Schedules to determine covered vaccines and any restriction to the use of the vaccine codes. (See Appendix A for information on
A PROVIDER S GUIDE TO PREVENTIVE HEALTH SERVICES FOR YOUR PATIENTS
ConnectiCare, together with the Centers for Medicare & Medicaid Services, encourages the use of preventive health services. For certain basic preventive health services, ConnectiCare Medicare Plan beneficiaries
Intensive Behavioral Therapy for Obesity Guidelines
Health First Technologies Inc. dba Renua Medical 777 E. William Street, Suite 210 Carson City, NV 89701 877-885-1258 775-546-6156 E-fax www.renuamedical.com Intensive Behavioral Therapy for Obesity Guidelines
2018 Reimbursement Information for Mammography, CAD and Digital Breast Tomosynthesis 1
GE Healthcare 2018 Reimbursement Information for Mammography, CAD and Digital Breast Tomosynthesis 1 May 2018 www.gehealthcare.com/reimbursement This advisory addresses Medicare coding, coverage and payment
Cpt code for excision cyst axilla. Cpt code for excision cyst axilla
Paieška Paieška Paieška Cpt code for excision cyst axilla Cpt code for excision cyst axilla > > CPT code is 21556, I am studying for cpc exam, had a really hard time finding the answer to this one so had
A A ~l~js AM f'ricj\n ACADBl\IY OF 0RTllOPAEDIC SURGEONS ~ J AMERICAN A SOCIATION OF ORTHOPAEDIC SURGEONS. Therapy billing for beginners
Therapy billing for beginners http://www.aaos.org/news/aaosnow/nov10/managing1.asp 1 of 4 3/25/2014 2:56 PM A A ~l~js AM f'ricj\n ACADBl\IY OF 0RTllOPAEDIC SURGEONS ~ J AMERICAN A SOCIATION OF ORTHOPAEDIC
Appendix C Podiatriac Services
Appendix C Podiatriac Services CPT/ HCPCS Codes Description Auth required Y or N Mod Service Limits Age Limits Notes 10021-10022 Fine Needle Aspiration w/ or w/o imaging guidance 10060-10061 10120-10121
Breast debridement and closure cpt
Breast debridement and closure cpt Close Breast debridement cpt code Medicare Billing Guidelines, Medicare payment and reimbursment, Medicare codes. Here is a list of CPT codes and Diagnoses that are.
2/21/
Medical Billing Made Easy Presents Optimizing Office Visits for Preventive Services Beginning now www.kareo.com Today s Program Introduction Presentation: Betsy Nicoletti, M.S., CPC Kareo Special Offer:
Slide 1. Slide 2 The Scream by Edvard Munch, Slide 3
1 Jan DiSantostefano, MS, NP SAS Institute, Inc. Cary, NC Jdisantostefano@nc.rr.com November, 2011 2 The Scream by Edvard Munch, 1893 2 3 1893 - in France by a physician, Jacques Bertillion. Bertillon
NEW YORK STATE TEAMSTERS COUNCIL HEALTH & HOSPITAL FUND APPENDIX A SCHEDULE OF BENEFITS SUPREME BENEFITS
BENEFIT GUIDE NEW YORK STATE TEAMSTERS COUNCIL HEALTH & HOSPITAL FUND APPENDIX A SCHEDULE OF SUPREME IN NETWORK FEATURES Primary Care Physician Not Required 2 Physician Referrals Not Required 2 Out of
Medicare Program; Revisions to Payment Policies Under the Physician Fee. Schedule and Other Revisions to Part B for CY 2016; Corrections
This document is scheduled to be published in the Federal Register on 03/08/2016 and available online at http://federalregister.gov/a/2016-05054, and on FDsys.gov CMS-1631-F2 DEPARTMENT OF HEALTH AND HUMAN
Claim Submission. Agenda 1/31/2013. Payment Basics
February 2013 Jean C. Russell, MS, RHIT jrussell@epochhealth.com Richard Cooley, BA, CCS rcooley@epochhealth.com 518-430-1144 2 Payment Basics Agenda 2013 PT / OT / SP Codes Deleted Codes New Codes Significant
Are You Sure You Can Bill Preventive Services? Disclaimer
Are You Sure You Can Bill Preventive Services? AAPC Regional Conference Chicago, Illinoisi October 2012 1 Disclaimer The information in this presentation was current at the time the presentation was complied
Schedule of Benefits for General Practitioners
Schedule of Benefits for General Practitioners Aviva Health Insurance Ireland Limited SCHEDULE OF BENEFITS FOR GENERAL PRACTITIONERS FROM AVIVA HEALTH INSURANCE IRELAND LIMITED Welcome to Aviva s schedule
11/19/2013. Cardiac Rehabilitation Coverage and Documentation Requirements. Phases of Cardiac Rehabilitation. Phase II
Cardiac Rehabilitation Coverage and Documentation Requirements Phases of Cardiac Rehabilitation Phase I: Acute in-hospital phase of CR Phase II: is the initial outpatient phase of the program Phase III:
Telehealth Billing. April 19, 2018
Telehealth Billing April 19, 2018 We want to offer telehealth in our office as an added service line to our patients. How do we indicate to the insurance company that the visit was a telehealth visit?
Impact of WRVU Changes. Allowed Charges (Millions)
Key Financial and Operational s from the Proposed 2018 PFS Rule: The 2018 Physician Fee Schedule (PFS) proposed rule was made available on July 13, 2018. A detailed summary of the rule will be available
40126 Federal Register / Vol. 75, No. 133 / Tuesday, July 13, 2010 / Proposed Rules
40126 Federal Register / Vol. 75, No. 133 / Tuesday, July 13, 2010 / Proposed Rules Q. Section 4103: Medicare Coverage of Annual Wellness Visit Providing a Personalized Prevention Plan 1. Background a.
All Providers. All Hospice Providers. All Ambulance Providers
INDIANA HEALTH COVERAGE PROGRAMS B A N N E R P A G E All Providers B R 2 0 0 8 0 5 J A N U A R Y 2 9, 2 0 0 8 CPT 90660 Influenza Virus Vaccine, Live for Intranasal Use The age restriction for Current
Chapter 11 Worksheet Code It
Class: Date: Chapter 11 Worksheet 3 2 1 Code It True/False Indicate whether the statement is true or false. 1. Surgical destruction is considered part of the surgical procedure description. 2. Prepping
Physician s Compliance Guide
Physician s Compliance Guide Updates to this guide will be posted on the Optum website and can be found at: http://www.optumcoding.com/product/updates/2013pcg/pcg13 Please use the following password to
2017 Coding and Reimbursement Survival Guide
2017 Coding and Reimbursement Survival Guide Chapter 14: Otolaryngology CPT 2017: Latest CPT Edition Offers New Code for Injection Laryngoplasty Changes could impact your reimbursement. The New Year is
Medicare Claims Processing Manual Chapter 5 - Part B Outpatient Rehabilitation and CORF/OPT Services
Medicare Claims Processing Manual Chapter 5 - Part B Outpatient Rehabilitation and CORF/OPT Services Transmittals for Chapter 5 Table of Contents (Rev. 3454, 02-04-16) 10 - Part B Outpatient Rehabilitation
Archived SECTION 19 - PROCEDURE CODES. Section 19 - Procedure Codes
SECTION 19 - EDURE CODES 19.1 CPT AND HCPCS CODES...3 19.2 PARTICIPANT COST SHARING AND COPAY...3 19.3 HCY/EPSDT VISION SCREENING...4 19.4 OPTICAL EDURE CODES...5 19.4.A EYE EXAMINATIONS...5 19.4.B FRAMES...5
CHAP3-CPTcodes _final doc Revision Date: 1/1/2015
CHAP3-CPTcodes10000-19999_final10312014.doc Revision Date: 1/1/2015 CHAPTER III SURGERY: INTEGUMENTARY SYSTEM CPT CODES 10000-19999 FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES
Introduction to 3M EAPGs
Introduction to 3M EAPGs (3M Enhanced Ambulatory Patient Groupings) February 23, 2017 Anne Boucher 3M Health Information Systems Outline 1. Definition of the EAPG Classification System Reference systems
Medicare Claims Processing Manual
Medicare Claims Processing Manual Chapter 32 Billing Requirements for Special Services Table of Contents (Rev. 3811, 07-25-17) (Rev. 3815, 07-28-17) Transmittals for Chapter 32 10- Diagnostic Blood Pressure
Chapter 15 Section 1
Chapter 15 Section 1 Issue Date: November 6, 2007 Authority: 32 CFR 199.14(a)(3) and (a)(6)(ii) 1.0 APPLICABILITY This policy is mandatory for the reimbursement of services provided either by network or
AUTHORIZATION RQUIREMENTS Notes (0= No Additional Comments) 101 All inclusive room and board On 0
100 All inclusive room and board 0 101 All inclusive room and board 0 114 Room and Board- private psychiatric 0 116 Room and Board- private room detoxification 0 118 Room and Board- private rehabilitation
The ABCs of Coding Pediatric Clinic Procedures
The ABCs of Coding Pediatric Clinic Procedures Facilitated by JoAnne M. Wolf, RHIT, CPC Objectives and Agenda To network with colleagues To understand the coding and required documentation of common ped
2015 Reimbursement Information for Mammography, CAD and Digital Breast Tomosynthesis 1
GE Healthcare 2015 Reimbursement Information for Mammography, CAD and Digital Breast Tomosynthesis 1 April, 2015 www.gehealthcare.com/reimbursement This advisory addresses Medicare coding, coverage and
Medicare Preventive Services and Screenings
Welcome to PMI s Webinar Presentation Brought to you by: pmimd.com Meet the Presenter Linda D'Spain, CMPE, CMC, CMIS, CMOM, CMCO On the topic: Medicare Preventive Services and Screenings Welcome to s Webinar
NEW YORK STATE MEDICAID PROGRAM CHIROPRACTOR MANUAL
NEW YORK STATE MEDICAID PROGRAM CHIROPRACTOR MANUAL POLICY GUIDELINES Table of Contents SECTION I - REQUIREMENTS FOR PARTICIPATION IN MEDICAID...2 WHO MAY PROVIDE CARE...2 LIMITED CHIROPRACTIC SERVICE
LOUISIANA MEDICAID PROGRAM ISSUED: 02/01/12 REPLACED: 02/01/94 CHAPTER 5: PROFESSIONAL SERVICES SECTION 5.1: COVERED SERVICES PAGE(S) 6
Diabetes Education Management Training Diabetes self management training (DSMT) is a collaborative process through which recipients with diabetes gain knowledge and skills needed to modify behavior and
Lumify. Lumify reimbursement guide {D DOCX / 1
Lumify Lumify reimbursement guide {D0672917.DOCX / 1 {D0672917.DOCX / 1 } Contents Overview 4 How claims are paid 4 Documentation requirements 5 Billing codes for ultrasound: Non-hospital setting 6 Billing
Preventative and Immunization Brochure
Preventative Immunization Brochure Table Of Contents 2016 Medicare Advantage Preventative Visits Guidelines... 1 Preventative Visits... 3 Common Preventive Services s*... 5 Additional Services Provided
2013 UPDATE ON PREVENTION & SCREENING IN THE ELDERLY West Virginia Geriatrics Society October 3, 2013
2013 UPDATE ON PREVENTION & SCREENING IN THE ELDERLY West Virginia Geriatrics Society October 3, 2013 Joy Pelfrey, RN, MSN, FNP, NEA-BC Director of Senior Service Line Objective Providers will understand
Current Site of Service Reductions
Site of Service differential is a reimbursement reduction for selected procedure codes when the service is performed in a hospital inpatient, outpatient, emergency room, or ambulatory surgery facility.
Page 1 of 11. Effective 9/15/2018 AUTHORIZATION REQUIREMENT LEVEL OF CARE. Notes (0 = No Additional Comments)
100 All inclusive room and board On 0 101 All inclusive room and board On 0 104 Anesthesia, ECT On 0 114 Room and Board- private psychiatric On 0 116 Room and Board- private room detoxification On 0 118
and at the same patient encounter. Code has been deleted. For scanning computerized ophthalmic diagnostic imaging of optic nerve and retin
92227: Remote imaging for detection of retinal disease (eg, retinopathy in a patient with diabetes) with analysis and report under physician supervision, unilateral or bilateral. For Medicare, bill only
HF10 THERAPY 2018 Ambulatory Surgery Center Reimbursement and Coding Reference Guide
HF10 therapy, delivered by the Nevro Senza System, is the high-frequency spinal cord stimulation technology operated at 10,000 Hz designed to aid in the management of chronic intractable pain of the trunk
2017 Reimbursement Information for Mammography, CAD and Digital Breast Tomosynthesis 1
GE Healthcare 2017 Reimbursement Information for Mammography, CAD and Digital Breast Tomosynthesis 1 February 2017 www.gehealthcare.com/reimbursement This advisory addresses Medicare coding, coverage and
CPT 2017 American Medical Association. All Rights Reserved. Charts 2018 American College of Obstetricians and Gynecologists. All Rights Reserved.
2018 National Physician Fee Schedule CPT codes and descriptions only are copyright 2017 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. COLUMN 1 COLUMN 2 COLUMN 3 COLUMN
OIG Work Plan for Orthotics
OIG Work Plan for Orthotics February 1, 2018 We recently heard that the government will be focusing audits on off the shelf orthotics. We have tried to find information but have not been successful. Are
Outpatient Billing Expert. A complete guide to APC and ASC daily billing requirements
Outpatient Billing Expert A complete guide to APC and ASC daily billing requirements Contents Introduction... Introduction 1 Outpatient Billing Expert Website... Introduction 2 Outpatient Billing Expert
MEDICAL & RX BENEFIT MATRIX. American Environmental Group/HSA Plan EFFECTIVE DATE: MEDICAL & RX BENEFITS
MEDICAL & RX BENEFIT MATRIX American Environmental Group/HSA Plan EFFECTIVE DATE: 01-01-2011 MEDICAL & RX BENEFITS SCHEDULE OF BENEFITS MEDICAL BENEFITS COVERED SERVICE/PLAN IN-NETWORK OUT-OF-NETWORK CATEGORY
2018 Cerebrovascular Reimbursement Coding Fact Sheet
The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Cordis Corporation concerning levels of reimbursement, payment,
Arizona Clover Health Choice PPO (040) 2019 Medical Benefits
Arizona 2019 Medical Benefits Effective Date: 1/1/2019 Version 1.0 Part D Deductible For Part D Copay information, see page 26. /year for Part D prescription drugs /year for Part D prescription drugs Out-of-Pocket
Cpt code for optometry vision impaired
Cpt code for optometry vision impaired» Логин или E-mail Пароль Запомнить Войти This code is generally not covered for greater than 12-18 visits within a 4-6 week period. Documentation must support the
Medicare Preventive Services
Medicare Preventive Services Presented by Cahaba Government Benefit Administrators, LLC Provider Outreach & Education March 24, 2010 Disclaimer This resource is not a legal document. This presentation
Working Smarter. Coding For Orthopaedic Trauma; Receiving Correct Reimbursement for Complex Cases
Coding For Orthopaedic Trauma; Receiving Correct Reimbursement for Complex Cases 1 Presenting the claims for appropriate payment Unless the documentation is clear Coders cannot properly code No basis of
Medicare Claims Processing Manual
Medicare Claims Processing Manual Chapter 32 Billing Requirements for Special Services Table of Contents (Rev. 4111, 08-10-18) Transmittals for Chapter 32 10- Diagnostic Blood Pressure Monitoring 10.1
Timely Topic Medicare Coding And Billing For Vaccinations. Wednesday, June 28, :00 4:30 PM ET
Timely Topic Medicare Coding And Billing For Vaccinations Wednesday, June 28, 2017 3:00 4:30 PM ET Welcome and Reminders Please be prepared for sharing and open discussion Slides and a recording from today
Coding for Preventive Services A Guide for HIV Providers
Coding for Preventive Services A Guide for HIV Providers Jessie Murphy, MPH and Michelle Cataldo, LCSW, April 2016 Implementation of the Patient Protection and Affordable Care Act and other regulatory
Pennslyvania Green (Plan 028) 2018 Medical Benefits
Pennslyvania Green (Plan 028) 2018 Medical Benefits Effective Date: 1/1/2018 Version 1.0 Part D Deductible For Part D Copay information, see page 25. $150/year for Part D prescription drugs Tiers 1 and
Georgia Green (Plan 026) 2018 Medical Benefits
Georgia Green (Plan 026) 2018 Medical Benefits Effective Date: 1/1/2018 Version 1.0 Part D Deductible For Part D Copay information, see page 26. Out-of-Pocket Max $100/year for Part D prescription drugs
A Guide to Billing Mammograms, PAP Tests, Pelvic Exams and Colon Cancer Screenings. Medicare Preventive Services: Women s Health
A Guide to Billing Mammograms, PAP Tests, Pelvic Exams and Colon Cancer Screenings Medicare Preventive Services: Women s Health For additional free Medicare education and training opportunities, including
Diagnostic and interventional venous procedures (lower extremity)
2017 Coding and Medicare payment guide Diagnostic and interventional venous procedures (lower extremity) All coding, coverage, billing and payment information provided herein by Philips Volcano is gathered
PROGRAM CHANGES TO ACCOMMODATE INFLUENZA A (H1N1) VACCINE FOR SWINE FLU CLAIMS
103009 NEWS BLAST PROGRAM CHANGES TO ACCOMMODATE INFLUENZA A (H1N1) VACCINE FOR SWINE FLU CLAIMS To accommodate the new Influenza A (H1N1) vaccine for Swine Flu, i.e., Administration (Adm) code 90470 and
MEDICAL & RX BENEFIT MATRIX. American Environmental Group/PPO Plan HSB Customer Service: EFFECTIVE DATE: MEDICAL & RX BENEFITS
MEDICAL & RX BENEFIT MATRIX American Environmental Group/PPO Plan HSB Customer Service: EFFECTIVE DATE: 01-01-2011 MEDICAL & RX BENEFITS SCHEDULE OF BENEFITS MEDICAL BENEFITS COVERED SERVICE/PLAN IN-NETWORK
This section includes billing guidelines and treatment information for alternative care providers including:
Alternative care Alternative care overview This section includes billing guidelines and treatment information for alternative care providers including: Acupuncturists/East Asian Medicine Practitioners
Zachary Edgar JD, LLM
Zachary Edgar JD, LLM 2019 Changes Annual Update Assistants Functional Reporting KX Modifier Manual Review NCCI Edits Merit-Based Incentive Payment System (MIPS) Annual Update The 2019 Annual Update has
It s good to have options
DPCMH PLANS (Direct Primary Care Medical Home) At the center of Aliera s PrimaCare TM Senior program is the Direct Primary Care Medical Home model of care. We modified this simple, but effective, model
Understanding Your Costs and Coverage
Understanding Your Costs and Coverage Thank you for choosing UW. We know that understanding your healthcare costs can be a challenge we re here to help. Your healthcare costs depend on many factors such
2016 Medicare Physician Fee Schedule. Final Rule Summary
2016 Medicare Physician Fee Schedule Final Rule Summary On October 30, 2015, the Centers for Medicare and Medicaid Services (CMS) released the Final Medicare Physician Fee Schedule (MPFS) for 2016. The
Revised - See 04/02/2013 Version
CHA/P Codes License for Use of Current Procedural Terminology, Fourth Edition (CPT) Notice The CPT code descriptions herein have been shortened to 28 characters or less to comply with copyright restrictions.
PQRS in TRAKnet 2015 GUIDE TO SUBMIT TING AND REPORTING PQRS IN 2015 THROUGH TRAKNET
PQRS in TRAKnet 2015 GUIDE TO SUBMITTING AND REPORTING PQRS IN 2015 THROUGH TRAKNET What is PQRS? PQRS is a quality reporting program that uses negative payment adjustments to promote reporting of quality
Welcome to Medicare: Exam Overview
Welcome to Medicare: Exam Overview June 8, 2016 Agenda Opening Remarks Housekeeping Polling Questions Presentations Polling Questions Q&A Closing Remarks 2 Introduction to the atom Alliance Multi-state
SW MI Breast & Cervical Cancer Control Navigation Program (FONDLY KNOWN AS BCCCNP)
SW MI Breast & Cervical Cancer Control Navigation Program (FONDLY KNOWN AS BCCCNP) Program Eligibility Age 40 64 for breast/cervical screening/diagnostic/treatment services Age 21 39 for breast/cervical
Ambulatory Surgery Visits (no ED visits) - Top CPT Codes All Facilities October 1, 2010 through September 30, 2011
Ambulatory Surgery Visits (no ED visits) - Top Codes All Facilities 1 66984 CATARACT SURG W/IOL 1 STAGE 94,744 6.95 6.95 2 45378 DIAGNOSTIC COLONOSCOPY 79,565 5.84 12.79 3 43239 UPPER GI ENDOSCOPY BIOPSY
2014 UPDATE ON PREVENTION & SCREENING IN THE ELDERLY West Virginia Geriatrics Society
2014 UPDATE ON PREVENTION & SCREENING IN THE ELDERLY West Virginia Geriatrics Society Medicare s Preventive Services and the New Annual Wellness Visit Todd H. Goldberg MD CMD FACP Assoc. Prof. / Chief
Local Coverage Determination for Colorectal Cancer Screening (L29796)
Page 1 of 15 Home Medicare Medicaid CHIP About CMS Regulations & Guidance Research, Statistics, Data & Systems Outreach & E People with Medicare & Medicaid Questions Careers Newsroom Contact CMS Acronyms
Connecticut Teachers' Retirement Board 2019 Medicare Supplement Plan Benefits -- Administered By Stirling Benefits. General information
Provider access Covered Benefits Deductible General information All providers who accept If covers a charge, then the TRB plan covers that charge The 2019 deductible is $185. The member pays the Part B
2/14/2018 CODING PITFALLS IN THE ASC AVERAGE RISK VS HIGH RISK SCREENING TOP CODING PITFALLS
CODING PITFALLS IN THE ASC Presented by: Kristin Vaughn, CPC, CGCS, CPMA, ICDCT-CM Healthcare Consultant and Lead Auditor AskMueller Consulting, LLC Kristin@askmuellerconsulting.com TOP CODING PITFALLS
2019 Medicare Physician Fee Schedule Proposed Rule
2019 Medicare Physician Fee Schedule Proposed Rule Welcome Thank you for joining today s 2019 Medicare Physician Fee Schedule webinar Webinar materials will be available after the meeting ends Questions?
Schedule of Benefits
3 Patient Protection and Affordable Care Act ( PPACA ) Compliance: The Plan will at all times be in compliance with PPACA rules and regulations. Notes regarding the Plan This Plan provides coverage for
MetroPlus Health Plan SCHEDULE OF BENEFITS MetroPlus Gold
SECTION XXIV MetroPlus Health Plan SCHEDULE OF BENEFITS MetroPlus Gold COST-SHARING Deductible Individual Family Out-of-Pocket Limit Individual Family $0 $0 $7,150 $14,300 except as required for emergency
Reimbursement Policy and Billing Guidelines for Chiropractic Services Effective April 1, 2006 for all BCBSMA Products (Revised September 2007)
Reimbursement Policy and Billing Guidelines for Chiropractic Services Effective April 1, 2006 for all BCBSMA Products (Revised September 2007) Policy Statement Blue Cross Blue Shield of Massachusetts (BCBSMA)
Consolidated Billing in a SNF
Consolidated Billing in a SNF Kris Mastrangelo, OTR/L, LNHA, MBA President & CEO Harmony Healthcare International (HHI) We C.A.R.E. About Care Version 12.15.17 About Kris Kris Mastrangelo, OTR/L, LNHA,