Medical Billing

Centers for Medicare & Medicaid Services (CMS) is announcing an expansion of its accelerated and advance payment program for Medicare participating health care providers and suppliers, to ensure they have the resources needed to combat the 2019 Novel Coronavirus (COVID-19). This program expansion, which includes changes from the recently enacted Coronavirus Aid, Relief, and Economic Security (CARES) Act, is one way that CMS is working to lessen the financial hardships of providers facing extraordinary challenges related to the COVID-19 pandemic, and ensures the nation’s providers can focus on patient care. There has been significant disruption to the healthcare industry, with providers being asked to delay non-essential surgeries and procedures, other healthcare staff unable to work due to childcare demands, and disruption to billing, among the challenges related to the pandemic. “With our nation’s health care providers on the front lines in the fight against COVID-19, dollars and ...

New CPT® Code for Corona or COVID-19 Most recently, the CPT Editorial Panel approved a new Category I Pathology and Laboratory code for novel coronavirus testing. This code is effective March 13, 2020. 87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19], amplified probe technique This is an early release code, so you will need to manually upload this code descriptor into your electronic health record system. CPT® 87635 will be a child code under parent code 87471 Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana, amplified probe technique in the 2021 CPT® code set.

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...