Medical Billing

For both the modifier OP report must be submitted, according Medicare: The Medical Review department has determined that many claims are being denied for lack of information regarding modifiers 52 and 53. Modifier 52 – Reduced Services Modifier 53 – Discontinued Procedure If modifier 52 is used and the procedure is surgical, an operative report must be submitted along with the claim and a separate concise statement indicating how the service differs from the usual. If the reduced procedure is non-surgical, a statement or report must be submitted describing how the service performed differs from the usual. If modifier 53 is used for a surgical procedure, an operative report is required. If the procedure is not surgical, a statement or report of how the procedure performed differed from the usual must be submitted with the claim.

The procedure 59400 for the routine maternity care including vaginal delivery, the below four codes for routine global billing ·          59400 ·          59510 ·          59610 ·          59618 The above four procedure means of billing for provider for services rendered for throughout pregnancy global OB, it means the above procedure consist of Antepartum( prenatal)   delivery and postpartum ( Post natal), plus hospital admission, physical examination, normal or C-Section delivery, discharge et., Here routine services means, physician who cover Prenatal, delivery and Postnatal.

Why Medicare reduced 2012 deductible from 2011?

W-9 Form W-9 is Internal Revenue Services (IRS) request for Tax Payers identification number, mainly its used for third parties to collect ID information like Name, Address to help file information returns with IRS. Also its is used to help payee avoid backup withholding. It is required for your name, Address and SSN number or employer identification number. When your giving out W-9 form be caution, because W-9 form contains sensitive information’s. Why Insurance Company ask W-9 Form from hospital or clinic etc., Because medical billing is cycle indirectly or directly insurance company’s are working for hospital or clinic etc., for them we need to report SSN number / business tax id. As far as       W-9 is form is concern it is straight forward with the all the above mentioned information, also they need to pay to address, or to update their records, or to check / update records. Note: W-4 Form is used by employer ...

CMS announce that Medicare adding coverage for a number of preventive services to reduce cardiovascular disease. According to CMS “Access to preventive services helps Medicare beneficiaries identify health risk factors and disease early to provide greater opportunities for early treatment,” said CMS Administrator Donald M. Berwick, M.D.  “CMS continues to carefully and systematically review the best available medical evidence to identify those preventive services that can keep Medicare beneficiaries as healthy as possible for as long as possible.”

Part A Premium ·          No Need to pay if already paid 40 or more quarters of MCR covered employment ·          30 – 39 Quarters Part A Premium $248 per month ·          Less than 30 Quarters of Medicare covered employment $451 Part B Premium Part B Premium $99.90 in 2012, $15.50 decrease from 2011 Deductible & Co Insurance Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2012 = $1,156) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days. For each benefit period you pay:   A hospital stay of 1-60 days $1,156 61-90 of a hospital stay $289  91-150 $578 per day for days  of a hospital stay (Lifetime Res...