Make sure you are CMS compliant and are using the new ABN Forms effective 6/31/17. Below there is a link to the website to download the new form.
Medical Billing & Coding service providers are now increasingly common in many areas of the USA, because they help fill a void faced both by Physicians, health care providers and patients alike. These companies work towards increasing and protecting the reimbursements due for medical services rendered. The mechanism that achieves this is medical coding. Submission of medical claims by individuals is often rejected for payment due to critical data being fed inaccurately, omissions in vital details, and typographical errors in the documentation. To redress this, services of medical billing are outsourced to companies who have trained staff to handle and understand the complexities inherent in the health care industry.
Codifying of medical billing procedure enhances ability to process claims accurately
Basically, Medical Billing & Coding is a process where medical data is translated into alphanumeric codes and each code represents a value assigned for a range of medical issues, covering diagnoses, surgery, disease symptoms, and drug after effects. These coding systems built into the billing edifice provide the function of setting a benchmark for accurate calculation of physician reimbursement, fairly assessing hospital payments under a system of measurement and quality review.
Medical billing Coding services ease complexities in health care Management
Medical Billing and Coding is actually the outsourcing of medical billing to service providers under a complex set of solutions to tackle billing reimbursements and help physicians achieve greater efficiency in practice management. Medical Billing Coding addresses the challenging task of completing immediate processing of bills, ensure compliance with specified norms, avoid under pricing errors and uncover areas where charges might have escaped attention resulting in reduced practice earnings.
Skilled persons are trained to combine medical software with billing parameters
Medical Billing Coding is best handled by experienced and skilled professionals with requisite technical abilities and training to effectively blend the intricacies of the software used in medical billing along with the coding systems that are in place. Basically, the crux of the coding system lies in its functionality to deliver the advantages that enables the system to process easy and accurate reimbursement of claims, maintain effective follow up on unpaid bills, and provide prompt information feedback on areas of concern.
In March 2016, CMS and the NCCI announced that they would remove the current edit prohibiting the reporting of CPT codes 77295 and 77300. The change will take effect today, July 1, 2016 (retroactive to January 1, 2016) and will be finalized in the July version of the NCCI Manual. Reporting requirements may vary by payer.
Providers (hospitals, physicians and freestanding cancer centers) should continue to track and capture the supported work of code 77300 during the 3D planning process. When the transmittal is released, providers will be able to submit those charges, along with the retroactive charges, for payment and in accordance with documentation guidelines and published Medically Unlikely Edits (MUEs).
Background: CMS originally implemented the prohibition of reporting these codes together (implemented January 1, 2016) because they believed the work of 77300 was integral to the work of 77295. Therefore, it should not be considered a separately reportable procedure. Opponents believed that this NCCI edit misinterpreted the work performed under these codes, resulting in unfair and significant payment cuts for radiation oncologists and facilities who were performing these critical procedures. This edit has since been removed (announced March 2016, effective July 1, 2016).
The Codes in Question:
77300: Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician.
77295: 3-dimensional radiotherapy plans, including dose-volume histograms.
CPT 90654 Payment allowance is $ 18.918. Effective dates: 8/1/2014-7/31/2015
CPT 90655 Payment allowance is pending. Effective dates: 8/1/2014-7/31/2015
CPT 90656 Payment allowance is $ 14.096. Effective dates: 8/1/2014-7/31/2015
CPT 90657 Payment allowance is $ 6.022. Effective dates: 8/1/2014-7/31/2015
CPT 90661 Payment allowance is $ 21.666. Effective dates: 8/1/2014-7/31/2015
CPT 90662 Payment allowance is $ 33.374. Effective dates: 8/1/2014-7/31/2015
CPT 90672 Payment allowance is $ 25.736. Effective dates: 8/1/2014-7/31/2015
CPT 90673 Payment allowance is $ 37.193 Effective dates: 9/26/2014-7/31/2015
CPT 90685 Payment allowance is $ 23.900. Effective dates: 8/1/2014-7/31/2015
CPT 90686 Payment allowance is $ 17.984. Effective dates: 8/1/2014-7/31/2015
CPT 90687 Payment allowance is $ 9.134. Effective dates: 8/1/2014-7/31/2015
CPT 90688 Payment allowance is $ 16.844. Effective dates: 8/1/2014-7/31/2015
HCPCS Q2035 Payment allowance is $ 11.885. Effective dates: 8/1/2014-7/31/2015
HCPCS Q2036 Payment allowance is $ 8.579. Effective dates: 8/1/2014-7/31/2015
HCPCS Q2037 Payment allowance is $ 15.396. Effective dates: 8/1/2014-7/31/2015
HCPCS Q2038 Payment allowance is $ 12.044. Effective dates: 8/1/2014-7/31/2015
HCPCS Q2039 Flu Vaccine Adult – Not Otherwise Classified payment allowance is to be determined by the local claims processing contractor with effective dates of 8/1/2014-7/31/2015