decisionhealth Newsletters, Coder Pink Sheets - 2018 Issue 11 (November)
MAC opens up same-day E/M billing for NPPs of different specialties
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Article Overview
This article covers a regional Medicare Administrative Contractor policy update that affects same-day evaluation and management billing for non-physician practitioners in different specialties. It is relevant to billing staff, practice managers, and coding professionals who work with Medicare claims, specialty-based provider reporting, and denial management. The discussion focuses on the context for the policy change, the types of claims affected, and the general claim-submission information practices must provide.
Why This Topic Matters
The update may reduce avoidable denials and appeals for practices that bill Medicare for multiple same-day visits by non-physician practitioners. Understanding the policy is important for groups with multiple specialties, claims workflow responsibilities, and revenue cycle operations.
Article Sections
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Policy change for same-day NPP billing
Introduces the regional Medicare contractor update and describes the broader reporting issue it addresses for same-day services.
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Easing provider burden
Explains the policy context, including the contractor’s stated rationale and the operational trend behind the change.
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3 more points to get claims paid
Summarizes the claim-submission considerations discussed in the article, including diagnosis and timing issues that affect processing.
What You Will Learn
- How a regional Medicare contractor policy change affects same-day billing for non-physician practitioners
- Why the update matters for denial reduction and appeals management
- What general claim information practices must provide for these encounters
- How the article frames the operational impact for multispecialty groups
Who Should Read This
- Medical coders
- Billing staff
- Revenue cycle teams
- Practice managers
- Healthcare consultants
- Compliance staff
Codes Discussed
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