Medical Billing

ICD-10-CM Diagnosis Code J40 Bronchitis , not specified as acute or chronic   Bronchitis ;    Chest cold; Laryngotracheobronchitis; Tracheobronchitis; acute bronchitis (J20.-);  Allergic bronchitis NOS (J45.909-);   Asthmatic bronchitis NOS (J45.9-);   Bronchitis due to chemicals, gases, fumes and vapors (J68.0);   Bronchitis NOS; Bronchitis with tracheitis NOS;  Catarrhal bronchitis ; Tracheobronchitis NOS; code to identify:;  Exposure to environmental tobacco smoke (Z77.22);  Exposure to tobacco smoke in the perinatal period (P96.81);  History of tobacco dependence (Z87.891);  Occupational exposure to environmental tobacco smoke (Z57.31);  Tobacco dependence (F17.-);  Tobacco use (Z72.0)

Unified Program Integrity Contractors (UPIC) Audits UPIC stands for Unified Program Integrity Contractors. UPICs primary goal is to investigate instances of suspected fraud, waste, and abuse in Medicare or Medicaid claims. UPICs have nearly replaced ZPICs (Zone Program Integrity Contractors) as the primary mechanism for CMS to pursue fraud and abuse audits. They develop investigations early, and in a timely manner, take immediate action to ensure Medicare Trust Fund monies are not inappropriately paid. They also identify any improper payments that are to be recouped by the MAC (Medicare Administrative Contractor). Actions the UPICs take to detect and deter fraud, waste, and abuse in the Medicare program include: Investigate potential fraud and abuse for CMS administrative action or referral to law enforcement; Conduct investigations in accordance with the priorities established by CPI 's Fraud Prevention System; Perform medical review, as appropriate; Perfo...

What is Charge Entry : When the initial procedure of registration of patients is completed, the treatment is carried out. Based on the doctor’s medical impressions and the indications in the super-bill, the coding of procedure and diagnosis codes are done by the coder. Based on the procedure and diagnosis codes coded by the coder, the charge entry is done for the treatment rendered to the patient and the claim is submitted to the insurance carrier for payment. This would include entering details like Date of Service, Referring Physician, Ordering Physician, Place of Service, Type of Service, CPT Codes, ICD Codes, Modifiers, Authorization or Referral Details and Co-pay Details. However most of the above mentioned process are automated 

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Modifier Definition MA Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition. MB Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access. MC Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues. MD Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances. ME The order for this service adheres to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional. MF The order for...

CMS removed Social Security Number (SSN)-based Health Insurance Claim Numbers (HICNs) from Medicare cards and are now using Medicare Beneficiary Identifiers (MBIs) for Medicare transactions like billing, eligibility status, and claim status. CMS worked closely with business partners: Social Security Administration SSA United States Rail Road Retirement board  RRB Every person with Medicare has been assigned an MBI. The MBI is confidential like the SSN and should be protected as Personally Identifiable Information. According to CMS Everyone MUST  submit claims using MBIs, no matter what date of services was performed, with a few exceptions. Medicare plan exceptions: Appeals -  People filing appeals can use either the HICN or the MBI for their appeals and related forms. Adjustments  - You can use the HICN indefinitely for some systems (Drug Data Processing, Risk Adjustment Processing, and Encounter Data) and for all records,...

The Centers for Medicare and Medicaid Services (CMS) have issued new identification cards to Medicare beneficiaries featuring the new Medicare Beneficiary Identifier (MBI), How MBI Format looks like: 1) 11-character combination of letters and numbers. 2) Made up only of numbers and uppercase letters (no special characters); if you use lowercase letters, our system will convert them to uppercase letters. 3) Clearly different than the HICN and RRB number. The MBI doesn’t use the letters S, L, O, I, B, and Z to avoid confusion between some letters and numbers (e.g., between “0” and “O”). Hospice providers need this number when admitting a patient into service. What do MBIs mean for people with Medicare? The MBI doesn't change Medicare benefits. People with Medicare who belong to a Medicare Advantage plan or a Medicare drug plan (Part D) should keep using their Medicare Advantage and/or Medicare drug plan cards like they always have when they get heal...

Medicare Physician Fee Schedule for 2020 1. Payment update. CMS proposed increasing physician payment rates by 0.14 percent in 2020. After applying the budget-neutrality adjustment required by law, CMS estimated the 2020 Physician Fee Schedule conversion factor is $36.09, up from $36.04 in 2019. 2. Evaluation and management coding and payment. Under the proposed rule, separate payment rates would be set for all five levels of coding for evaluation and management visits. 3. Medical record documentation. The proposed rule would allow physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse-midwives to review and verify information in a patient's medical record that is entered by other clinicians, rather than re-entering the information. 4. Telehealth services. CMS proposed adding a set of codes, which describe a bundled episode of care for treatment of opioid use disorders, to the list of telehealth services covered by M...

CMS released three proposed new Payment rules on July 29, which include payment updates for outpatient and physician services and expanded price transparency initiatives. Here are 8 things from CMS proposed rules for 2020: Medicare Outpatient Prospective Payment System 1. Payment update. CMS proposed increasing the OPPS payment rates by 2.7 percent in 2020 compared to 2019. The agency estimates total payments to OPPS providers will be roughly $6 billion higher in 2020 than this year. 2. Price transparency. The proposed rule builds on previous price transparency guidance from CMS by defining "standard charges" to include the hospital's gross charges and payer-specific negotiated rates for an item or service. Hospitals would be required to publish all standard charges online in a machine-readable file. In addition, the rule would require hospitals to publish payer-specific negotiated rates for 300 services consumers are likely to shop for, includi...