Billing & Coding

Virtual Cards

Sometimes called "disposable," "temporary" or "one-time use" numbers, a virtual credit card number is "like putting a wall" between your transaction and your regular account, says Steve Kenneally, vice president of the American Bankers Association. Although these cards can protect the cardholder from fraud, the use of virtual cards as a form of electronic funds transfers (EFT) payments for healthcare services can present some problems for healthcare providers.

Healthcare Reform (Resource 156)

Even though the health care system in the United States is one of the most expensive per capita in the world, we have a dismally low quality of care ranking. Healthcare reform (HCR) in its simplest terms is addressing these shortcomings in order to improve healthcare coverage, delivery, policies, or payment. According to wikipedia, "healthcare reform typically attempts to:

Provider Non-Discrimination FAQ by CMS

40-Effect of Beneficiary Agreements Not to Use Medicare Coverage

(Rev. 160, Issued: 10-26-12, Effective: 01-28-13, Implementation: 01-28-13)

(Rev. 194, 09-03-14)

 

(Rev. 1487, Issued: 04-08-08, Effective: 04-01-08, implementation: 04-07-08)

Centers for Medicare & Medicaid Services (CMS) is establishing four new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.”

Be sure your billing staff is aware of the modifier changes!

The primary issue associated with the -59 modifier is that it is defined for use in a wide variety of circumstances, such as to identify:

  • Different encounters;
  • Different anatomic sites; and
  • Distinct services.

 The -59 modifier is:

Medicare Quarterly Provider Compliance Newsletters are an educational tool designed to provide education on how to avoid common billing errors and other erroneous activities when dealing with the Medicare Program. It includes guidance to help health care professionals address and avoid the top issues of the particular Quarter.

Joint DME MAC/PDAC Publication

The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have evaluated the MyoPro® upper extremity assist device and determined that it falls within the Durable Medical Equipment (DME) benefit category. Claims for MyoPro® should be submitted using the DME miscellaneous code E1399.

In the case of collagen dressings coded A6021A6022

Unsure of the date of service to bill on your claim form? The date of service for custom-made orthotics and prosthetics is the actual date the beneficiary receives the item. Do not use the date the item was ordered when billing Medicare.

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