Billing & Coding

CNN reported an astounding number of individuals charged with false billing. There was about $900 million in false billing that involved Medicare and Medicaid fraud. Along with the $900 in false billing, $36 million in Detroit involved a front for a narcotics diversion scheme. There were 301 defendants charged in the United States involving 61 medical professionals’ 36 Federal Judicial districts and 28 doctors were charged.

To help the understanding of what is covered under Dental and what may be covered under Medical, review Regence's coverage criteria:  

Coverage under medical or dental benefits is determined by the condition that is being diagnosed and treated, regardless of whether the service is provided by a dentist or a medical doctor.

MEDICAL POLICY CRITERIA

Note: Member contracts for covered services vary. Member contract language takes precedent over medical policy.

I. Dental Services

NAMAS Weekly Auditing and Compliance Tips

Introduction

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What is an Other Qualified Healthcare Professional?

To begin to answer this question, let's review the exact wording in the CPT codebook:

Our interactive course lets all participants have fun while learning. We teach to all

learning styles through games, computer teaching, lecture and interactivity. All

participants will understand how and why medical billing can be a profit center in

the dental practice.

After a very successful first course in Las Vegas, Laurie Owens will be teaching with Christine Taxin. As a

former student who has done an outstanding job working with a large Implant &

Periodontal Associates in Seattle Washington. She has contributed to the growth

The AMBA is the largest association in the nation that provides education, resources and credentials for independent, third party medical billers and doctor's office billers. The AMBA provides their services to medical billers that work from their home, office, or in physician offices. Billers can become certified through the AMBA by passing the Certified Medical Reimbursement Specialist (CMRS) exam which is the highest standard certification for medical billers, period.

http://www.ambanet.net/AMBA.htm

The Diagnostic and Statistical Manual for Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States. It is generally accepted as the authoritative guide for the diagnosis of mental disorders. This FAQ article was created to address some commonly asked questions about DSM coding and clear up some common misconceptions.
 

Read entire article on InstaCode Institute   https://instacode.com/DSM-FAQ

Modifiers are used to help describe the encounter, and used to further explain the procedure to the payer. Modifiers will be used if the procedure does not fit or clearly explain the entire encounter.  

There are two types of modifiers:

  • Informational modifiers that do not impact reimbursement
  • Pricing or Payment modifiers that always impact reimbursement

Claims processing requires the pricing modifier in the first position to be processed correctly.

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