Medical Billing

Medicare New Card with new ID, part of MACARA Initiative. Medicare will mail new Medicare cards between April 2018 and April 2019. Your new card will have a new Medicare number that’s unique to you, instead of your Social Security number. This will help to protect your identity. The new card won’t change your coverage or benefits. You don’t need to take any action to get your new Medicare card. Medicare will never contact you for your Medicare number or other personal information. Don’t share your Medicare number or other personal information with anyone who contacts you by phone, email, or by approaching you in person.

Approved preventive health services with co insurance and Deductible waived. G0101 G0296 G0402 99406 99407 G0438 G0439 G0442 G0443 G0444 G0445 G0446 G0447 Q0091

What is MACRA ? MACRA stands for Medicare Access & CHIP Reauthorization Act 2015 : Three major steps : 1) Ending sustainable growth rate for determining Medicare payment for health care provider service 2) Making new framework for rewarding health care provider for giving better care not just more care 3) Combining our existing quality reporting program's in to one new system These proposed changes replace a patchwork system of Medicare reporting program's with a flexible system that allows you to choose two path of links quality of payments . MIPS - Merit based Incentive Payment System. It's a combination of PQRS, Value based payment modifier and EHR. APM  - Alternative Payment Model 2019 - 2024 Lump sum incentive amount, increased transparency of physician focused payment model. Starting 2026, offers some participating health care provider higher annual payment. SOCIAL SECURITY NUMBER REMOVAL INITIATIVE MACRA Requires us to remove SSN from all Medicare ca...

Description for 1P: Medical reasons Guidelines for 1P Modifier: In general, PQRI quality measures consist of a numerator and a denominator that permit the calculation of the percentage of a defined patient population that receive a particular process of care or achieve a particular outcome. Where a patient falls in the denominator population but specifications define circumstances in which a patient may be excluded from the measure’s denominator population, CPT Category II code modifiers 1P, 2P, and 3P are available to describe medical, patient, or system reasons, respectively, for such exclusion CPT modifier 1P: the quality measure was not applied due to medical reasons This modifier is only valid with some measures This modifier may only be reported with the CPT Category II codes for quality measures. It does not apply to HCPCS codes for quality measures. Refer to each individual quality measure for specific indications for this modifier

Description for AQ: Physician providing a service in a health professional shortage area. Guidelines/Instructions for AQ: Submit HCPCS modifier AQ in the following instances: When you provide services in ZIP code area that does not fall entirely within a designated full county HPSA bonus area When you provide services in a ZIP code area that falls partially within a full county HPSA but is not considered to be in that county based on the USPS dominance decision When you provide services in a ZIP code area that falls partially within a non-full county HPSA When you provide services in a ZIP code area that was not included in the automated file of HPSA based on the date of the data run used to create the file When services are provided in areas that were eligible for the HPSA bonus on December 31 of the prior year but were not on the automated ZIP code list  Designated HPSAs change periodically, so it is important to verify that services f...

Description: HCPCS Modifier Q6 Services furnished by a locum tenens physician Guidelines/Instructions for Q6: Guidelines Submit HCPCS modifier Q6 to indicate that services were provided under a locum tenens arrangement. Locum tenens background: Physicians may retain substitute physicians to take over their professional practices when they are absent for reasons such as illness, pregnancy, vacation or continuing medical education These substitute physicians, known as 'locum tenens' physicians, generally have no practice of their own and move from area to area as needed The regular physician generally pays the substitute physician a fixed per diem amount. The substitute physician's status is that of independent contractor, rather than employee, and his/her services are not restricted just to the physician's office. Services of non-physician practitioners (e.g., CRNAs, NPs and PAs) may not be billed under the locum tenens or reciprocal billing reassig...

Modifier 58, Staged or related procedure or services by the same Physician or other Qualified Health care Professional during the postoperative period. When to Use modifier 58 Modifier 58 is used to identify those situations when a procedure or services may be staged(planned). While a return to the operating room for a related procedure may be commonplace, a staged (planned) procedure or services may not be as routine. I will try to clarify the intent when to exactly use modifier 58 with the procedure code. As per the CPT coding guidelines, Modifier 58 is assigned for any subsequent procedure, Which is planned or has to be performed with the related original procedure. Following three key points should be remembered before appending modifier 58 to the procedure codes. Modifier 78 Unplanned return to the operating / procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative pe...