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HIPAA Final Rule Eliminates HPID and OEID


Final rule eliminates the requirement for health plans to obtain a unique health plan identifier (HPID) and also eliminates the voluntary use of the other entity identifier (OEID). This change becomes effective December 27, 2019.

tags  Specl: All Specialties    Topic: HIPAA   

And Then There Were Fees...


Find-A-Code offers fees and pricing for just about everything, this article will address two of some of the most common payment systems with CMS. (OPPS) -Outpatient Medicare Outpatient Prospective Payment System. (MPFS)- Medicare Physician Fee Schedule The Fees section on each code page is determined on the type of services...

tags  Payer: CMS|Medicare    Specl: All Specialties    Topic: CMS1500    Topic: Fees    Topic: UB04 Form and Coding   

Are you providing TMD treatment and having a hard time receiving payment from Medical? Take a look at the law for your state!


  TM TREATMENT AND THIRD PARTY INSURANCE COVERAGEMinnesota, in 1987, became the first state to adopt legislation requiring health insurance policies issued within the state to include coverage for the diagnosis and treatment of temporomandibular (TMD) joint disorders and craniomandibular (CMD) disorders on the same basis as other joint disorders. At ...

tags  Loc: Arkansas    Loc: California    Loc: Florida    Loc: Georgia    Loc: Illinois    Loc: Kentucky    Loc: Maryland    Loc: Minnesota    Loc: Mississippi    Loc: Nevada    Loc: New Mexico    Loc: North Carolina    Loc: North Dakota    Loc: Tennessee    Loc: Texas    Loc: Vermont    Loc: Virginia    Loc: Washington    Loc: West Virginia    Loc: Wisconsin    Specl: Dental    Specl: Oral and Maxillofacial Surgery   

VA: How UCR Charges are Determined


How does the VA determine charges billed to third party payers for Veterans with private health insurance? According to the VA. "38 C.F.R 17.101 stipulates the basic methodology by which VA bills third party insurance carriers. In order to generate a charge for medical services, VA establishes reasonable charges for five ...

tags  Payer: VA - Veterans Administration    Topic: Fees   

VA- Reasonable Charges Rules, Notices, & Federal Register


tags  Payer: All Payers    Payer: VA - Veterans Administration    Specl: All Specialties    Topic: Fees    Topic: Reimbursement    Topic: UB04 Form and Coding   

Medically Unlikely Edits (MUEs): Unlikely, But Not Always Impossible


Medically Unlikely Edits (MUEs) were created by the Centers for Medicare & Medicaid Services (CMS) to help lower the error rate for paid Part B claims. MUEs are the maximum units of a HCPCS or CPT code that a provider would bill under most circumstances for the same patient on ...

tags  Specl: All Specialties    Specl: Billing    Topic: CPT Coding    Topic: Modifier Coding   

ICD-10 Appendix E


Z00.00 Z01.20 Z02.3 Z03.810 Z34.00 Z38.4 Z51.11 Z52.4 Z00.01 Z01.21 Z02.4 Z03.818 Z34.01 Z38.5 Z51.12 Z52.5 Z00.110 Z01.30 Z02.5 Z03.89 Z34.02 Z38.61 Z52.000 Z52.6 Z00.111 Z01.31 Z02.6 Z04.1 Z34.03 Z38.62 Z52.001 Z52.810 Z00.121 Z01.411 Z02.71 Z04.2 Z34.80 Z38.63 Z52.008 Z52.811 Z00.129 Z01.419 Z02.79 Z04.3 Z34.81 Z38.64 Z52.010 Z52.812 Z00.2 Z01.42 Z02.81 Z04.41 Z34.82 Z38.65 Z52.011 Z52.813 Z00.3 Z01.810 Z02.82 Z04.42 Z34.83 Z38.66 Z52.018 Z52.819 Z00.5 Z01.811 Z02.83 Z04.6 Z34.90 Z38.68 Z52.090 Z52.89 Z00.70 Z01.812 Z02.89 Z04.71 Z34.91 Z38.69 Z52.091 Z76.1 Z00.71 Z01.818 Z02.9 Z04.72 Z34.92 Z38.7 Z52.098 Z76.2 Z00.8 Z01.82 Z03.6 Z04.8 Z34.93 Z38.8 Z52.10 Z99.12 Z01.00 Z01.83 Z03.71 Z04.9 Z38.00 Z39.0 Z52.11 Z01.01 Z01.84 Z03.72 Z31.81 Z38.01 Z39.1 Z52.19 Z01.10 Z01.89 Z03.73 Z31.82 Z38.1 Z39.2 Z52.20 Z01.110 Z02.0 Z03.74 Z31.83 Z38.2 Z42.1 Z52.21 Z01.118 Z02.1 Z03.75 Z31.84 Z38.30 Z42.8 Z52.29 Z01.12 Z02.2 Z03.79 Z33.2 Z38.31 Z51.0 Z52.3 ...

tags  Topic: ICD10CM Coding   

Now That is Fraud! Genetic Testing "Public alert"


Genetic testing is becoming very popular. In fact, so popular you might see it in places you would not expect such as a community event, fairs or any event happening in your community. Some labs may even offer FREE screening for genetic testing. Watch for FREE screening announcements or advertisements ...

tags  Payer: CMS|Medicare    Specl: Laboratory|Pathology    Topic: Fraud    Topic: OIG   

CMS says Codes are on the Move!


Have you noticed your LCDs are missing something? CMS is moving codes out of LCDs and into Billing and Coding Articles. MACs began moving ICD-10-CM, CPT/HCPCS, Bill Type, and Revenue codes in January 2019, and will continue through January 2020. Therefore, if there is an LCD with its codes removed, you will find ...

tags  Payer: CMS|Medicare    Specl: All Specialties    Topic: LCDs and NCDs   

Why is HIPAA So Important?


Why is HIPAA So Important? Some may think that what they do to protect patient information may be a bit extreme. Others in specialty medical fields and research understand its importance a little more. Most of that importance lies in the information being protected. Every patient has a unique set of ...

tags  Payer: CMS|Medicare    Specl: All Specialties    Topic: HIPAA    Topic: Practice Management   

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