Medical Billing

Medicare offers more health coverage choices and decreased premiums in 2018  According to CMS Medicare Advantage premiums decrease, choices increase, while enrollment hits an at all-time high Today, the Centers for Medicare & Medicaid Services (CMS) announced that people with Medicare will have more choices and options for their Medicare coverage in 2018. As CMS releases the benefit and premium information for Medicare health and drug plans for the 2018 calendar year, the average monthly premium for a Medicare Advantage plan will decrease while enrollment in Medicare Advantage is projected to reach a new all-time high. Earlier this year, CMS announced new policies that support increased benefit flexibilities allowing Medicare Advantage plans the ability to offer innovative plans that fit the needs of people with Medicare.   "More affordable choices lead to greater health security for those who need it most,” said Health and Human Services Secretary Tom Price...

Both Medicare beneficiaries and providers have certain rights and protections related to financial liability under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (MA) Programs. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers: FFS Advance Beneficiary Notice of Noncoverage (FFS ABN) FFS Home Health Change of Care Notice (FFS HHCCN) FFS Skilled Nursing Facility Advance Beneficiary Notice (FFS SNFABN) and SNF Denial LettersFFS Hospital-Issued Notices of Noncoverage (FFS HINNs) FFS Expedited Determination Notices for Home Health Agencies, Skilled Nursing Facility, Hospice and Comprehensive Outpatient Rehabilitation Facility  (FFS Expedited Determination Notices) MA Denial Notices (MA Denial Notices) MA Expedited Determination Notices (MA Expedited Determination Notices) Important Message from Medicare (IM) and Detailed Notice of Discharge (DND) (Hospital Discharge Appe...

 the 2016 Physician Fee Schedule Final Rule, CMS updated the regulation text found at 42 CFR 414.904(j) to make clear that effective January 1, 2016, the payment amount for a biosimilar biological drug product is based on the average sales price of all NDCs assigned to the biosimilar biological products included within the same billing and payment code. In general, this means that CMS will group biosimilar products that rely on a common reference product’s biologics license application into the same payment calculation, and these products will share a common payment limit and HCPCS code. In order to provide CMS with the ability to track claims payment and to develop a better understanding of the use of specific biosimilar products in Medicare Part B, claims for separately paid biosimilar biological products will be required to include a modifier that identifies the manufacturer of the specific product. Modifiers will be used to distinguish between biosimilar products that ap...

Texas Top Claim Submission / Reason Code Errors - August 2017 # Explanation of Medicare Benefits Message Description Resolution 1 96 Non-covered charge. Prior to performing or billing a service, ensure that the service is covered under Medicare. Please refer to the Centers for Medicare & Medicaid Services Internet Only Manual, 100-02, Chapter 16. 2 109 Claim not covered by this payer/contractor. This denial indicates that the service is one that is processed or paid by another contractor. Examples of these types of service are: Durable Medical Equipment Hospice related services Medicare Advantage You must send the claim to the correct payer/contractor. 3 18 Duplicate claim/service. Please check claim status through the IVR to see if another claim was paid or is currently being processed. To prevent duplicate denials, allow us sufficient time to process a claim before submitting a second. 4 50 These are non-covered services because this is not deemed a 'm...

All of the BCBS plans have been posting announcements about the new alpha/numeric prefixes that they’re going to be rolling out next year. Below is the announcement that Anthem put in a recent newsletter: New member ID prefixes coming in 2018 The Blue Cross and Blue Shield Association (BCBSA) assigns member ID prefixes for all Blue Cross and Blue Shield branded Plans – Anthem Plans as well as non-Anthem Plans. There are a limited number of unused three-character, alpha only prefixes remaining, and they are expected to be exhausted in the 2nd or 3rd quarter of 2018. When that happens, the BCBSA will begin assigning prefixes that contain a combination of letters and numbers, or alpha-numeric prefixes. What does this mean to you? It will be even more important to ask your patients for their most recent identification (ID) card.When submitting claims, enter the identification number exactly as it appears on the member’s ID card.Check your EDI Software to make sure it ca...