Medical Billing

Sequestration Medicare Payment reductions in Medicare Fee-For-Services.   For DOS or Date of discharge on or after April 1 st 2013, your Physicians payment will be reduce by 2% reason code may be OA-121, Sequestration adjustments etc., Beginning this April 2013 there will be 2% reduction in doctor’s payment Stating Sequestration Its mandatory across the board reductions in federal spending. In general Medicare FFS claims with DOS or date of discharge on or after April 1, 2013, will incur 2% reduction in Medicare payment its includes DME services. Patient cost sharing remains same it means patient have to pay to 20% Co insurance 2% will be reduced only from the 80% of the allowed amount. See below explanation . Medicare allows $100 Patient Share $20 Payment to Physicians $78.40 Sequestration $1.60 Interestingly not only Medicare even Medicare HMO may follow Medicare Sequestration adjustments.  

Malcolm Baldrige Criteria for Performance Excellence. Sector Wise: Education Healthcare Manufacturing NonProfit/Government Services Small Business Malcolm Baldrige Healthcare Healthcare industries looking for improve safety and outcome & reducing cost. Health Care Criteria for Performance Excellence · Patient safety and patient loyalty · Health care outcomes for acute myocardial infarction, heart failure, pneumonia, and other conditions · Physician and staff satisfaction and engagement, especially among registered nurses · Revenue and market share · Community service The Baldrige Criteria for Performance Excellence Provide a systems perspective for understanding performance management. They reflect validated, leading-edge management practices against which an organization can measure itself. With their acceptance nationally and internationally as the model for performance excellence, the Criteria repre...

A patient is considered an after-hours patient only if he reports to the office after your normal office hour’s end , not when he presents during normal office hours and the appointment runs past closing time that will not be considered as After-hours .  99050: Physician sees a patient in the office during hours when the practice would normally be closed, such as on weekends or after 5 p.m., as long as the documentation supports the afterhours service. Example: If your practice normally closes at 4 p.m. on Fridays, but your physician sees a patient at 7 p.m. and conducts a level-three established patient visit, you should bill 99213 and 99050 (for the after-hours visit). Even CPT guidelines allows you to bill 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed e.g., holidays, Saturday or Sunday in addition to basic service) . 99051: If your practice is normally open during evening hour...