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By Namas | Published August 16th, 2019 - Last Review/Update August 20th, 2019
Medical ID Theft
"So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...
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By Namas | Published August 9th, 2019 - Last Review/Update August 14th, 2019
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
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By BC Advantage | Published July 12th, 2019 - Last Review/Update July 30th, 2019
Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability.
Take ...
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Understanding ASC Pricing
November 22nd, 2017
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published November 22nd, 2017
ASCs (Ambulatory Surgical Centers) have a separate fee schedule with a base allowed amount that is adjusted for each state using Core Based Statistical Areas (CBSA). Under the ASC payment system, Medicare pays facilities for specific ASC covered surgical procedures, however, there are only certain types of procedures that are eligible for payment ...
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Advanced Life Support Ambulance Services: Insufficient Documentation
October 5th, 2016
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 5th, 2016
Ambulance suppliers often submit Medicare claims for Advanced Life Support (ALS) ambulance services which lack sufficient medical record documentation. The 2015 Comprehensive Error Rate Testing (CERT) Report states that the improper payment rate for ALS services was 14.5 percent with improper payments projected at $226 million. The most frequent errors ...
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Mandatory Assignment on Carrier Claims (Rev. 2487, Issued: 06-08-12)
July 17th, 2015
By Find-A-Code | Published July 17th, 2015
The following practitioners who provide services under the Medicare program are required to accept assignment for all Medicare claims for their services. This means that they must accept the Medicare allowed amount as payment in full for their practitioner services. The beneficiary’s liability is limited to any applicable deductible plus ...
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Ambulance Services Submitted to Carriers (Rev. 1, 10-01-03)
July 9th, 2015
By Find-A-Code | Published July 9th, 2015
Jurisdiction of the claim is based on whether only one ambulance vehicle or multiple vehicles were used.
A. One Ambulance Vehicle Used
If only one vehicle is used to transport the patient from the point of initial pickup to the final destination, jurisdiction is with the carrier serving the point of ...
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Clinical Laboratory, Ambulance and Medicare Part B Drugs for Indian Health Services (Rev. 1040, 09-11-06)
June 25th, 2015
By Jared Staheli | Published June 25th, 2015
Enrollment of IHS, tribe and tribal organization facilities providing clinical laboratory, ambulance services and Medicare Part B drugs must be provided through the designated carrier. These IHS, tribe and tribal organization facilities must meet all the usual enrollment requirements for the designated carrier. The designated carrier started accepting enrollment applications ...
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Carrier - Ambulance Services - Payment Policy for Indian Health Services (Rev. 1040, 09-11-06)
June 25th, 2015
By Jared Staheli | Published June 25th, 2015
Effective July 1, 2005, Medicare Part B payment may be made to IHS independent ambulance suppliers that furnish ambulance services. IHS independent ambulance suppliers bill the designated carrier for services.
Payment for independent ambulance supplier claims shall be based on the ambulance fee schedule and processed based on point of pickup ...
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Carrier – Ambulance Services - Claims Processing (Rev. 1040, 09-11-06)
June 25th, 2015
By Jared Staheli | Published June 25th, 2015
Medically necessary ambulances provided by an IHS ambulance supplier are paid based upon Chapter 15 of Pub. 100-04, Medicare Claims Processing Manual. Suppliers must report an origin and destination code for each ambulance service billed.
Modifier Reporting –
Origin and destination modifiers used for ambulance services are created by combining two alpha ...
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FI - Outpatient - Medicare Part B - Claims Processing for Indian Health Services (Rev. 2075, 01-28-11)
June 25th, 2015
By Jared Staheli | Published June 25th, 2015
All charges, except for therapies, telehealth originating site facility fee, PPV, influenza virus vaccine, hepatitis B vaccine and hospital-based ambulance services are combined and reported under revenue code 0510 (clinic visit) on TOB 13X (hospital outpatient).
Regardless of the number of times a patient is seen in a given day at ...
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FI - CAH Outpatient - Medicare Part B - Claims Processing for Indian Health Services (Rev. 1776, 01-04-10)
June 25th, 2015
By Jared Staheli | Published June 25th, 2015
All charges, except therapies, telehealth originating site facility fee, PPV, influenza virus vaccine, hepatitis B vaccine, and hospital-based ambulance services are combined and reported under revenue code 0510 (clinic visit) on TOB 85X (CAH).
Non-patient lab specimens are billed on TOB 14X (hospital other).
The MSN is suppressed.
See Chapter18, §10 of Pub. ...
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A/B MAC - Ambulance Services for Indian Health Services (Rev. 2102, 04-04-11)
June 25th, 2015
By Jared Staheli | Published June 25th, 2015
Section 630 of the MMA allows for the reimbursement of ambulance services provided by IHS hospital-based ambulance providers, CAHs, and entities owned and operated by a CAH, for the 5 year period beginning January 1, 2005. Section 2902 of the Affordable Care Act indefinitely extends Section 630 of the MMA, ...
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FI - Outpatient Hospital-Based Ambulance Services - Medicare Part B - Payment Policy for Indian Health Services (Rev. 1040, 09-11-06)
June 25th, 2015
By Jared Staheli | Published June 25th, 2015
Medically necessary ambulance services submitted by hospital-based ambulance providers are reimbursed based on the ambulance fee schedule.
The Medicare Part B deductible and coinsurance apply to ambulance services, but are waived by the IHS.
See Chapter 15, §30.2.4 of Pub. 100-04, Medicare Claims Processing Manual, for more information on the payment of ...
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FI - Outpatient Hospital-Based Ambulance Services - Medicare Part B - Claims Processing for Indian Health Services (Rev. 1040, 09-11-06)
June 25th, 2015
By Jared Staheli | Published June 25th, 2015
Outpatient ambulance bills from hospital-based ambulance providers are submitted with revenue code 054X (ambulance) with charges for ambulance, as well as the appropriate ambulance HCPCS codes on TOB 12X or 13X.
If an outpatient encounter occurs at the same time a covered ambulance service is provided, the hospital-based ambulance providers may ...
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A/B MAC - CAH Ambulance Services - Medicare Part B - Payment Policy for Indian Health Services (Rev. 2102, 04-04-11)
June 25th, 2015
By Jared Staheli | Published June 25th, 2015
For dates of service on or after December 21, 2000 and prior to January 1, 2004, medically necessary ambulance services provided by an IHS CAH or an entity that is owned and operated by the IHS CAH are paid based on 100 percent of the reasonable cost if the 35 ...
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FI - CAH Ambulance Services - Medicare Part B -Claims Processing for Indian Health Services (Rev. 1040, 09-11-06)
June 25th, 2015
By Jared Staheli | Published June 25th, 2015
Medically necessary ambulance services originating out of an IHS CAH with a hospitalbased ambulance service are submitted with revenue code 054X (ambulance) with charges for ambulance, as well as the appropriate ambulance HCPCS codes on TOB 85X. IHS CAHs that meet the 35 mile rule for cost based payment shall ...
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FI - Ambulance Services - Medicare Part A - Payment Policy for Indian Health Services (Rev. 1040, 09-11-06)
June 25th, 2015
By Jared Staheli | Published June 25th, 2015
If an inpatient is transferred to another hospital for services under arrangement, the ambulance services are not billable to Medicare. Reimbursement for such services is part of the inpatient stay and payment is included in the IPPS payment based on the DRG.
...
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