Medical Billing

CMS Provides State Medicaid websites Alabama http://www.medicaid.alabama.gov/apply/index_apply.aspx?tab=3 Alaska http://health.hss.state.ak.us/dpa/programs/medicaid/ Arizona http://www.azahcccs.gov/applicants/default.aspx Arkansas https://www.medicaid.state.ar.us/InternetSolution/Consumer/Consumer.aspx California http://www.dhcs.ca.gov/services/medi-cal/Pages/default.aspx Colorado https://peak.state.co.us/selfservice/ Connecticut http://www.ct.gov/dss/cwp/view.asp?a=2353&q=305218#MAID Delaware http://dhss.delaware.gov/dhss/dmma/medicaid.html District of Columbia http://dhcf.dc.gov/dhcf/cwp/view,A,1412,Q,609122.asp Florida http://www.fdhc.state.fl.us/Medicaid/index.shtml Georgia http://dfcs.dhr.georgia.gov/portal/site/DHSDFCS/ menuitem.83054cda1a084d2f7da1df8dda1010a0/?vgnextoid=36ca2b48d9a4ff00 VgnVCM100000bf01010aRCRD Hawaii http://hawaii.gov/dhs/health/medquest/QUEST_Overview Idaho http://www.healthandwelfare.idaho.gov/Medical/Medicaid/tabid/123/Default.aspx Illino

Advanced Beneficiary Notice form CMS-R-131 is the revised ABN form announced by CMS, For providers and suppliers its mandatory to use this version starts from September 1, 2011. According to CMS “Skilled nursing facilities (SNFs) must use the revised ABN for items/services expected to be denied under Medicare Part B only.” You can downloaded all the instruction from CMS website

Referral : A referral is an authorization provided by the Primary Care Physician referring a patient to a specialist.   Submitting a referral along with a claim is necessary to get reimbursement.  Pre-Authorization : The process of obtaining permission to perform a service from the insurance carrier before the service is performed is called Pre-authorization.   Prior authorization only required for certain type of procedures or specialty

Professional Compenent: The professional component is used to report the physician’s services only. In a treatment rendered to a patient, the professional component of it means the portion of the total service provided by the physician.  Technical Compenent:   In a treatment rendered to a patient, the technical component of it means the portion of the total services provided by the facility. This includes the cost of technologist’s services, specific equipment and supplies and any facility overhead necessary for providing the service such as room charges.