Medical Billing

DME is equipment that can withstand repeated use, is primarily used for a medical purpose, and is not generally used in the absence of illness or injury. Examples include hospital beds, wheelchairs, and oxygen delivery systems. Medicare will cover medical supplies that are necessary for the effective use of DME, as well as surgical dressings, catheters, and ostomy bags. However, Medicare will only cover DME and supplies that have been ordered or prescribed by a physician. The order or prescription must be personally signed and dated by the patient's treating physician.  DME suppliers that submit bills to Medicare are required to maintain the physician's original written order or prescription in their files. The order or prescription must include:  o the beneficiary's name and full address; o the physician's signature; o the date the physician signed the prescription or order; o a description of the items needed; o the start date of the order (if ap...

September 1 st 2014 is the US labor day, The Department of Labor's Unemployment Insurance (UI) programs provide unemployment benefits to eligible workers who become unemployed through no fault of their own, and meet certain other eligibility requirements. In the United States unemployment benefits generally pay eligible workers between 40-50% of their previous pay. Benefits are generally paid by state governments, funded in large part by state and federal payroll taxes levied against employers, to workers who have become unemployed through no fault of their own. This compensation is classified as a type of social welfare benefit. Eligibility : In order to receive benefits, a person must have worked for at least one quarter in the previous year and have been laid-off by an employer. Workers who were temporary or were paid under the table are not eligible for unemployment insurance. If a worker quits or is fired they are not eligible for UI benefits. There are five...

Whether the provider, Novitas Solutions, or another entity identifies an overpayment, the overpaid funds must be reimbursed to Novitas Solutions in one of the following ways: A.  Immediate Recoupment as a Means to Repay Medicare Debt - Part A and Part B The immediate recoupment process is for providers who have received an overpayment demand letter and are actively billing Medicare.  Immediate recoupment is not an alternative for sending a voluntary refund to Medicare. You may elect to have your overpayment(s) repaid through the immediate recoupment process and avoid paying by check or waiting for the standard recoupment that begins automatically on day 41 from the date of the initial demand letter.  A request for immediate recoupment must be received by Medicare in writing no later than 16 days from the date of the overpayment demand letter. You must specify whether you are submitting:  1. A one-time request for all invoices included in t...

Medicare is secondary to all accident related claims. Beneficiaries may not choose which of these claims will be paid by the automobile insurance and which claims will be paid by Medicare. Providers should submit all accident related claims to the automobile insurance before submitting them to Medicare. To avoid late claim filing, claims may be submitted to Medicare even though payment has not been received from the automobile insurer. In addition, conditional payment can be made by Medicare if 1) the automobile insurance will not pay promptly (within 120 days); or 2) due to physical or mental incapacity, the beneficiary fails to meet the claim filing requirements of the automobile insurer. Conditional payments are made on the condition that the beneficiary will reimburse Medicare if payment is later made by the automobile insurer. If the automobile insurance benefits are exhausted, Medicare requires a statement of exhaustion from the automobile insurer. The itemized st...

The BCRC contractor became responsible for updating the Medicare MSP files, answering general MSP questions or responding to COB concerns. MSP data may be updated, as necessary, based on additional information received from patients, providers, attorneys, or third parties. Development may be required in order to confirm the information. The BCRC contractor may be contacted at: 1-855-798-2627 or TDD/TYY 1-855-798-2627 Monday through Friday 8 a.m. to 8 p.m. Or Fax 734-957-9598 Or Address general written inquiries to: MEDICARE - MSP General Correspondence P.O. Box 138897 Oklahoma City, OK 73113-8897 Special Projects (e.g. all Product Liability Case Inquiries and Special Project Checks) Special Projects P.O. Box 138868 Oklahoma City, OK 73113 Self-Calculated Conditional Payment Amount Option and fixed Percentage Option Self-Calculated Conditional Payment Amount/Fixed Percentage Option P.O. Box 138880 Oklahoma City, OK 73113 Fax 1-405-869-3309 ...

Black Lung Benefit Act of 1973, It is USA government program, The Black Lung Benefits Act (BLBA) provides monthly payments and medical benefits to coal miners totally disabled from pneumoconiosis (black lung disease) arising from employment in or around the nation's coal mines. This Act also provides monthly benefits to a miner's dependent survivors if pneumoconiosis caused or hastened the miner's death. The Division of Coal Mine Workers' Compensation (DCMWC), within the U.S. Department of Labor Employment Standards Administration's Office of Workers' Compensation Programs (OWCP), adjudicates and processes claims filed by coal miners and their survivors under the BLBA. Medicare and BLBA Medicare is secondary for beneficiaries who have medical benefits under the Federal Black Lung Program. Medicare is secondary only for services provided for the treatment of lung conditions caused by mining. Claims for beneficiaries entitled to benefits under the F...

Modifier 24 24 Modifier Unrelated Evaluation and Management Service by the Same Physician During a Postoperative Period: Physician may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. An E/M service can be coded with modifier 24 to indicate a visit in the postoperative period that is unrelated to the original procedure (surgery). This modifier is not valid when coded with surgeries or other types of services. It is not appropriate for modifier 24 to be coded with diagnostic tests performed in the postoperative period. These are not part of the global surgical allowance and are always considered separately. In most cases, diagnosis codes that apply to the E/M service are different from the diagnosis codes indicated on the original procedure. However, in rare circumstances, the diagnoses are the same, but the services are unrelated; if so, this information should ...

Contact the EDI Department via our toll free number at 1-877-235-8073, Option 3 for JL or 1-855-252-8782, Option 3 for JH. Identify if you are billing directly or through a clearinghouse or billing service. If billing directly: Ask the Analyst to reissue you authorization letter. The letter will be mailed to the submitter address on file ,and will include your submitter ID and Login ID.  You will also need to verify who is listed as your software vendor.  If using PC-ACE Pro32, verify you have the program loaded on your computer and refer to the PC-ACE User Guide. (JL) (JH) If using another software vendor, please contact your vendor for help with the software. If using a billing service or clearinghouse: Ask the Analyst to give you the contact information for the billing service/clearinghouse. Please contact them directly for login and use information.

Contact the Customer Service department via our toll free number at 1-877-235-8073 for JL or 1-855-252-8782 for JH. After obtaining some information from the customer, the Customer Service Department will reissue the letter containing the PTAN. To obtain the NPI, the customer should contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 or via the NPPES website search tool.

According to Novitas :   This tool provides the status of Part A and B Appeal requests. Once you have entered your search criteria (defined below), click on "Submit Query". Do not hit the enter key. Search results are based on exact matches of the input criteria. Please ensure you enter search data exactly as it appears on your remittance advice or voiced from the IVR. You may not receive the results you are looking for if you submitted a multiple claim appeal using only one Redetermination form .  The case pending in our processing system will reference only one of the claim numbers.  For multiple claim cases submitted with one Redetermination form it is suggested to search using only the PTAN. And… If you submitted a Redetermination request form and did not provide a claim number the case pending in our processing system will not reference a claim number initially.  If you search using only the PTAN, you will see an open case, the receipt ...

REMINDER - Dial-up Customers Using the 717 Area Code Modem Telephone Number – Less Than Two Weeks Left   EDI trading partners still connecting to Novitas via the former 717 area code modem telephone number will no longer be able to connect for claim submission and report retrieval as of 12:01 AM Eastern Time (ET) on Friday, August 29, 2014 – that’s less than two weeks away! Effective August 29, 2014 at 12:01 AM ET , dial-up trading partners must transition to the new number, 904-371-9510 .  We have found that customers who have made the switch to the new dial-up number may need to down speed their modem if they are having difficulties connecting. The majority of our trading partners have already made these changes, and we appreciate your assistance with this effort.  Currently, customers still connecting through the 717 area code mode telephone number may already be experiencing: Inability to connect for claim submission, remi...

[800-829] Fractures. [800-804] Fracture of skull. [805-809] Fracture of neck and trunk. [810-819] Fracture of upper limb. [820-829] Fracture of lower limb. [830-839] Dislocation. [840-848] Sprains and strains of joints and adjacent muscles. [850-854] Intracranial injury, excluding those with skull fracture. [860-869] Internal injury of thorax, abdomen, and pelvis. [870-897] Open wound o. [900-904] Injury to blood vessels. [905-909] Late effects of injuries, poisonings, toxic effects, and other external causes. [910-919] Superficial injury. [920-924] Contusion with intact skin surface. [925-929] Crushing injury. [930-939] Effects of foreign body entering through orifice. [940-949] Burns. [950-957] Injury to nerves and spinal cord. [958-959] Certain traumatic complications and unspecified injuries. [960-979] Poisoning by drugs, medicinal and biological substances. [980-989] Toxic effects of substances chiefly non-medicinal as to source. [990-995] Other and uns...