Reimbursement and Coding

Medicaid Reimburses for Office Lab Services Members Only Document

Medicaid will now reimburse for some laboratory services provided in physician offices.

Medicaid Increases Ophthalmological Exam Reimbursement Members Only Document

Reimbursement for some opthalmological exams increased July 1, 2008.

Medicaid Increases Healthy Beginnings Plus Reimbursement Members Only Document

Medicaid has increased reimbursement for some Healthy Beginnings Plus program services.

Medicaid Will Cover Developmental and Autism Screenings Members Only Document

Medicaid will now cover screenings for developmental delays and autism spectrum disorders for patients younger than 21.

AMA Campaign Targets Cost of Submitting Claims
As part of its campaign to cut the cost of submitting claims to health insurers, the AMA has released a report card comparing how national insurers reimburse physicians.

Seminars to Address Workers' Compensation Billing and Payment
These seminars from the Bureau of Workers' Compensation will help you better understand workers' compensation billing and payment processes and the fee schedule.

Pittsburgh’s New Durable Medical Equipment Program Delayed
The Centers for Medicare and Medicaid Services (CMS) will change the way Medicare Part B will pay for some medical equipment in the Pittsburgh area.

Cigna Will Stop Reimbursing for Preventable Serious Complications Members Only Document

Cigna has joined a growing movement to stop reimbursing hospitals for preventable serious complications.

Physicians May Bill Medicare for Prolonged Visits in Nursing Facilities Members Only Document

Physicians will soon be able to bill Medicare for prolonged evaluation and management visits in skilled nursing facilities or nursing facilities, as long as the visits are prolonged for a medically necessary reason.

Audiologists Must Enroll in Medicare, Obtain NPI Members Only Document

Audiologists who wish to bill Medicare for services must enroll in Medicare and obtain a National Provider Identifier (NPI) by Oct. 1, 2008.

Medicare Expands Coverage of CPAP Devices Members Only Document

Medicare now will cover continuous positive airway pressure (CPAP) devices for beneficiaries who have been diagnosed with obstructive sleep apnea using a home sleep test, instead of just those diagnosed using a polysomnography sleep test.

Aetna, Cigna Reimburse for Online Consultations Members Only Document

The insurers will reimburse for online consultations for physicians who subscribe to the RelayHealth web service.

Medicaid Won't Reimburse Hospitals for Preventable Serious Complications
Medicaid will not reimburse hospitals for preventable serious complications—or “serious adverse events."

Aetna Tries to Set Payment Levels for Out-of-Network Physicians Members Only Document

Aetna is trying to set payment levels for out-of-network physicians at 125 percent of the Medicare fee schedule and telling patients that they do not have to pay the remaining balance.

UnitedHealthcare Changes Preventive Medicine and Screening Policy Members Only Document

UnitedHealthcare will now reimburse both a preventive service and a problem-oriented E&M service submitted with modifier 25 for the same patient on the same date of service.

Workers' Compensation Fees Increased for 2008
The WC Part B fee schedule increased in 2008.

Making the Health Plan Participation Decision
Medical practices should exercise caution when deciding which health plans they’ll participate in.

Workers' Compensation: The Application for Fee Review Process
A Workers' Compensation (WC) insurance carrier has 30 days to pay your bill, deny the worker's claim for benefits, or request a utilization review. If your payment is late or incorrect, file for fee review.

Collection Protocols for the Medical Practice
Manage your accounts receivable and prevent them from becoming delinquent. “Collection Protocols” includes tips on managing accounts and also useful collection techniques.

Act 6: A Crash Course in Auto Accident Reimbursement
A concise run-down of the steps you need to take to get appropriately reimbursed for care of patients injured in a motor vehicle accident.

Your Right to Timely Payment Under Act 68
Act 68 requires health insurers to remit payment for clean claims within 45 days of receipt.

Highmark Changes Definition of Personal Supervision for “Incident-to” Billing Members Only Document

Highmark Blue Cross and Blue Shield will allow some allied health professionals to bill under their cooperating physicians’ provider numbers for services performed when physicians are out of the office.

Billing Codes for “Welcome to Medicare” Exam Members Only Document

Medicare covers an initial physical exam and EKG for new enrollees. Other preventive benefits include diabetes and cardiovascular screening tests.

Billing Tactics to Maximize Revenue
Improve your practice's cash flow by implementing 10 tactics to maximize revenue.

Beware of Automatic Participation Clauses in Payer Contracts Members Only Document

Don't be fooled into thinking that you've washed your hands of a contract just because you didn't sign it. Automatic participation clauses require you to send a written opt-out notice within 60 days to void the agreement.

Highmark Blue Shield Multiple Surgery Guidelines Members Only Document

Highmark has routinely reimbursed physicians for multiple surgical procedures in a downward stepping stone method. Here's a synopsis of their reimbursement guidelines.

ICD-9, CPT Codes for Overweight, Obesity and Associated Complications Members Only Document

A list of codes most frequently used when treating overweight, obese, or at risk patients.

About PA-NEDSS: The Online Disease Reporting System
Physicians and practices must use this system to report communicable and non-communicable diseases.

CMS Delays Expansion of Anti-Markup Rule Members Only Document

The Centers for Medicare and Medicaid Services will delay expansion of a rule, which prohibits physicians from “marking up” certain diagnostic tests, from Jan. 1, 2008, to Jan. 1, 2009.

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