Can you collect 20% that Medicare does not cover from a Medi-Medi patient?
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Can you collect 20% that Medicare does not cover from a Medi-Medi patient?

Billing Statement Doctor

The short answer is “No”. Both state and federal law provide broad protections to Medicare/Medi-Cal dual eligible individuals, and prohibit billing a Medi-Cal patient in most circumstances. California’s Department of Health Care Services takes the position that a physician should first bill Medicare and then bill the Medi-Cal program for the services. Only if the Read more

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How to Achieve Success through Key Performance Indicators (KPIs)?

Healthcare Consulting

STEP 1 – Assess your Current Situation Look for opportunities to analyze your progress. By tracking and comparing key performance indicators, or KPIs, you can identify and address issues with productivity, reimbursement, claims submission, and other processes. Days to final bill—number of days from the time of service until provider generates and submits a claim Read more

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Advance Care Planning – New Payable Service

Advance Care Planning - 99497_99498

For the first time, the Centers for Medicare & Medicaid Services (CMS) made the Current Procedural Terminology (CPT) codes for Advance Care Planning (ACP) separately payable by Medicare. CPT codes 99497 & 99498 are used to report the face-to-face service between a physician or other qualified health care professional and a patient, family member, or Read more

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How to Read an EOB / ERA

ERA/EOB - Reimbursement

Many physician practices recognize the Health Information Portability and Accountability Act (HIPAA) as both a patient information privacy law and electronic patient information security law. However, HIPAA actually encompasses a number of regulations. As such, the federal government has published several “rules” that instruct the health care industry on how to comply with the law. Read more

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Got Paid? How to Handle Denials with ICD-10

ICD10_CMS

On October 1, the U.S. health care system moved to the International Classification of Diseases, 10th Revision (ICD-10). Recognizing that health care providers may need help with the transition, CMS has established an ICD-10 Ombudsman and ICD-10 Coordination Center to help track, triage, and resolve issues. Generally speaking, Medicare claims take several days to be processed Read more

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6 ICD-10 Changes for Primary Care

ICD10_CMS

DIABETES Diabetes (codes E08 – E13) has greatly expanded in ICD-10. Physicians must document whether the diabetes is Type 1, Type 2, drug- or chemical­ induced, or due to an underlying condition. They must document the specific underlying condition, the specific drug or toxin, as well as the use of any insulin (Z79.4). ICD-10 requires Read more

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Blue Shield Changes Its Fee Schedule

Blue Shield Logo

In a notice sent to physicians on September 23, Blue Shield notified physicians about a change in the physician fee schedule. The new fees took effect December 1, 2013.  The insurer said that it would be increasing payment for evaluation and management services for preventive care. Additionally, Blue Shield notes payment increases for the more Read more

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Close Your Year With Confidence!

Checklist_End of Year

The following is a brief guide to getting ready for the new year: Allowables Do you have any new insurance contracted amounts (allowables) that you need to load in your practice management software for the new year? If you do, load these new fees in your practice management. And, if you do not have your allowable Read more

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Medi-Cal to Increase Pay Rate to Match Medicare’s Rates

Medicaid to Medicare Fee Index

Pursuant to the Affordable Care Act (ACA) and 42 CFR 447, State Medicaid agencies are required to reimburse Primary Care Physicians with a specialty designation of Family Medicine, General Internal Medicine, or Pediatric Medicine or related pediatric sub-specialties, at parity with Medicare for specified Evaluation and Management (E&M) and Vaccine Administration services. On average, Medi-Cal reimbursement is Read more

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Charging for “Free” Forms!

Charging for Forms

Due to rising practice cost and declining reimbursements, most physicians are looking into charging for services that they have done for free for years. One of the new sources of revenue is charging patients for completing forms. Charging patients for forms comes with a risk. Patients are not accustomed to paying for it and this Read more

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