Claims Articles and Resources
News and Important Information
See also Chapter 1 - Insurance & Reimbursement in Find-A-Code's specialty specific Reimbursement Guides or the ChiroCode DeskBook for important claims processing information.
Additional Links and Resources
Billing Requirements for OPPS
Billing Requirements for OPPS Providers with Multiple Service Locations
Select the title to see a summary and a link to the full article.
October 15th, 2021
Is Your Organization Ready to Deal with Provider Relief Fund (PRF) Audit Contractors?
Published October 15th, 2021 - Last Review/Update October 19th, 2021|
Audits are currently underway to verify the monies distributed through the CARES Act were warranted and properly used by those organizations that received them. The federal government has contracted with financial institutions such as KPMG and PricewaterhouseCoopers, among others, to perform these audits referred to as Provider Relief Fund (PRF) audit contractors, funded with monies from the very same program. There were four phases of funding disbursements with phase 1 audits beginning in September. How ready are you to be audited?
September 29th, 2021
Published September 29th, 2021|
Injection Service Codes Injection service codes, are reported under administration of vaccines/toxoids, using 96372, 90460, 90461, 90471, 90472, 0001A, 0002A, 0003A, 0011A, 0012A, 0021A, 0022A, 0031A, 0041A, and 0042A. Other injections services include: Non-antineoplastic hormonal therapy injections – 96372 Anti-neoplastic nonhormonal injection therapy 96401 Anti-neoplastic hormonal injection therapy- 96402 Allergen immunotherapy - 95115-95117 According to CMS, do ...
August 4th, 2021
Understanding How Place of Service Codes Work
Published August 4th, 2021|
The Place of service (POS) codes are used by CMS, Medicaid, and other private insurance to indicate where medically related items and services are sold or dispensed for a patient. POS codes are used for professional billing and are required to be reported on each claim submitted on a CMS-1500 ...
June 29th, 2021
Compliance in the Dental Office or Small Practice
Published June 29th, 2021|
If your practice does not already have a compliance program in place, you will want to get started after reading this article. We have uncovered some important findings with the Office of Inspector General (OIG) in dental practices you need to be aware of. A compliance program offers standard procedures to follow, ...
May 12th, 2021
Since When did Dental Claims Require Diagnosis Codes?
Published May 12th, 2021|
The objective of the Accountable Care organization is to integrate and consolidate patient care management to improve patient outcomes. Changes and coordination of dental and medical care are already becoming more apparent when dental offices are being required to bill a patient's medical plan for dental visits due to an ...
May 3rd, 2021
UB-04 Claim Form
Published May 3rd, 2021|
The UB-04 Claim Form, also known as CMS-1450, is used for submitting claims for reimbursement for specially designated facilities. The 837i is the electronic version of the form. Much like the 1500 Claim Form, maintained by the National Uniform Claim Committee, the UB-04 Claim Form is maintained by the National Uniform Billing Committee (NUBC) which maintains lists of approved codes used on various fields on the form (e.g., revenue codes, condition codes). Third-party payers, including Medicare, may have their own adaptations of the general instructions published by the NUBC.
March 17th, 2021
Q/A: Why is My Claim Being Denied When I Report a Secondary Diagnosis Code?
Published March 17th, 2021|
Question: Recently my claims to Medicare are being denied when I submit a secondary diagnosis code. I’ve heard that this is happening in several states including Washington, California, and New York. Has there been a recent change in what secondary diagnosis codes are allowed?
November 18th, 2020
How to Search Find-A-Code for Medicare Policies and Guidelines — LCDs, NCDs and Articles —
Published November 18th, 2020|
Help for Searching Find-A-Code when searching for Medicare Policies and Guidelines — LCDs, NCDs and/or Articles.
November 18th, 2020
Cross-A-Code Instructions in Find-A-Code
Published November 18th, 2020|
Cross-A-Code is a tool found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.
August 5th, 2020
Coding with PCS When There is No Code
Published August 5th, 2020|
ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn? To the guidelines, of course! There are ICD-10-PCS guidelines just as ...
July 1st, 2020
Understanding UCR Inpatient Fees used on DRGs
Published July 1st, 2020|
March 24th, 2020
"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools
Published March 24th, 2020|
Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...
March 21st, 2020
Understand the New Codes for Testing & Reporting the COVID-19 Coronavirus (SARS-CoV-2)
Published March 21st, 2020|
The current coronavirus pandemic refers to COVID-19, a novel or new type of coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The first victim of the virus was identified in Wuhan, Hubei, China at the end of 2019. There is no immunization available to prevent it from spreading and ...
February 19th, 2020
Q/A: Did Noridian Stop Covering the M99.0- Codes?
Published February 19th, 2020|
Question: I heard that Medicare Noridian Jurisdiction F (Alaska) has been denying claims with M99.00, M99.01, M99.02, M99.03 etc codes when billed with the CMT CPT codes. Did Medicare change their policy?
January 9th, 2020
Who Knew? There are Three Types of Add-On Codes
Published January 9th, 2020|
Using add-on codes with HCPCS/CPT is not as simple as 123! Although there are three different groups of add-on codes assigned by CMS, these are used to identify code edits. It is easy to see the add-on code with some codes; we can see the instructional notes and phrases such ...
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Can I Perform 2 Untimed Codes at the Same Time?Claims Topic PageClaims Topic Page - ChiropracticData on Application and Coverage Denials - by Government Accountability OfficeDesignation of Authorized Representative Form - by ACAInstaGuide - Complete 1500 Claim Form Filing Instructions - by InstaCode InstituteLINK BROKE- ERISA FAQ Page - by the Dept of LaborMap of States & Jurisdictions - by the National Association of Insurance CommissionersMedicare Claims Processing Manual - Chapter 25Medicare Claims Processing Manual, Chapter 12Medicare Claims Processing Manual, Chapter 9 - Rural Health Clinics/Federally Qualified Health CentersMedicare Electronic Claims Exemption - by CMSOfficial DOL text regarding internal claims and appeals under PPACAParticipating vs. Non-Participating (Medicare Part B Claims)Q/A: How Do I Respond to a Patient's Request to Not Submit the Claim to Their Insurance?Reminder to Stop Billing Duplicate Claims by Medicare Learning NetworkScrub-A-Claim by Find-A-Code.comSelf-Funded Plans and the PPACA: Is this the new normal?Timely Claims Filing: Additional Instructions - MedLearn Article by CMSUB-04 FL 17 – Patient Discharge Status CodesUB-04 FLs 39-41 - Value Codes and AmountsUB04 Claim Form Instructions
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