Are You Ready for Noridian – Your New Medicare MAC?
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Are You Ready for Noridian – Your New Medicare MAC?

Medicare Transition to Noridian from Palmetto GBA

The Centers for Medicare & Medicare Services (CMS) first announced in September 2012 that Noridian Healthcare Solutions has been named the new Medicare Administrative Contractor (MAC) for Medicare Parts A and B in California, Nevada and Hawaii, as well as the U.S. territories of American Samoa, Guam and the Northern Mariana Islands (Jurisdiction E, previously called Jurisdiction Read more

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When is a “New Patient” Considered “NEW”?

Define a "New Patient" visit?

In 2012, the American Medical Association (AMA) revised its definition of a “New Patient” in its Current Procedural Terminology (CPT®) book. However, CPT®’s definition of a new patient did not mean Medicare would necessarily follow suit. Indeed, this change did not have any impact on Medicare Part B claims. CPT® defines a new patient as: Read more

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3 Common (But Misunderstood) Post-surgical Modifiers

Modifiers 58, 78, 79

There are several surgical modifiers but there are three in particular that are the most misunderstood among billers. Modifiers 58, 78, and 79 are used to define surgical procedures during global days with some variations. We have explained these nuances below: Modifier 58: Staged or Related Procedure or Service by the Same Provider During the Postoperative Read more

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CMS-1500 Claim Transition – UPDATE!

New CMS-1500 Finalized

On June 17, 2013 the Centers for Medicare & Medicaid Services (CMS) released the revised CMS-1500 Claim Form (version 02/12). The new CMS-1500 (02/12) will replace the current form (08/05). One of the reasons for this change is to support the use of the ICD-10 diagnosis code set. The revised form will give providers the ability Read more

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Hiring a Billing Company – Compliance Plan (Part 3)

Hiring a Billing Company

Does the Billing Company Have a Compliance Plan? One of the most important components of doing your due diligence in hiring a billing company is to ensure that they have an active compliance plan. In fact, having a compliance plan should be a hiring requirement. Having a compliance plan is imperative and, at the least, Read more

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Hiring a Billing Company – Pricing Guideline And Contract Terms (Part 2)

Hiring a Billing Company

Pricing Guideline In “Hiring a Billing Company – Due Diligence (Part 1)” we discussed the steps in determining a suitable billing company for your practice. One key point in deciding the best fit is to ensure that you are going to save money and also increase your revenue. At this stage of your due diligence Read more

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Hiring a Billing Company – Due Diligence (Part 1)

Hiring a Billing Company

Are you looking for ways to improve the efficiency of your billing and increase your bottom line? A medical billing service could be the answer. Many physicians already look to medical billing companies for assistance with their billing and collection functions. Most billing companies offer billing and collection services, plus a wide range of other Read more

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You Have a Good Chance of Winning Your Medicare Appeals

Claims appealed and recovered from Medicare

Medicare recovery audit contractors (RAC) receive a contingency fee of 9% – 12.5% of any overpayment they find but must return that money when a determination is overturned on appeal. Physicians and hospitals have a record of success when appealing RAC overpayment decisions, according to an analysis by the Centers for Medicare & Medicaid Services Read more

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2013 Coding Changes That Affect Your Patient Visits

CPT

The American Medical Association (AMA) made 650 CPT (Current Procedural Terminology) code changes in 2013 . The changes are effective with January 1, 2013, dates of service. Of all the new CPT changes, there were 82 Evaluation and Management (E/M) codes in the range 99201-99467. This article describes the changes in the E/M category. Evaluation Read more

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