Changes coming in 2021 2020 looks to be a transition year on the payment front, as many programs and changes expected to go into effect this year have been delayed until 2021. These include new CMS-created primary care models and a streamlining of evaluation and management level-of-care coding. CMS announced in October its newest alternative […]
An Integrated Delivery Network (IDN) is a formal system of providers and sites of care that provides both health care services and a health insurance plan to patients in a defined geographic area. The functionalities included in an IDN vary, but can include acute care, long-term health, specialty clinics, primary care, and home care services—all […]
Blue Cross Blue Shield Enhanced Ambulatory Patient Grouping (EAPG) methodology for calculating reimbursement for outpatient procedures http://www.okoha.com/OHA/Hotline/2015/April15/Taking_charge_of_the_EAPG__Improve_your_negotiations_with_BCBS.aspx
NCDs (National Coverage Determinations) and LCDs (Local Coverage Determinations) are decisions by Medicare and their administrative contractors that provide coverage information and determine whether services are reasonable and necessary on certain services offered by participating providers.
Enterprise Resource planning Enterprise resource planning (ERP) is an industry term for the broad set of activities that helps an organization manage its business. An important goal oF ERP is to facilitate the flow of information so business decisions can be data-driven. ERP software suites are built to collect and organize data from various […]
Medical Billing Acronym List
Here are some definitions for acronyms that may be helpful: http://bcbsmi.net/providers/help/faqs/medicare-advantage/provider-toolkit/acronym-list.html Acronym Definition ABN Advance beneficiary notice AIM American Imaging Management ASF Ambulatory surgical facilities BCN Blue Care Network BCBSM Blue Cross Blue Shield of Michigan BHC BlueHealthConnection® CAH Critical access hospital CCN CMS certification number CDTCLFS Current dental terminologyClinical Laboratory Fee Schedule CMS Centers […]
Look-up NPI’s, ICD 10 codes, HCPCS
I came across this website that has links to many Hospital Billing functions. Hospital and Billing Information Look-up
ICD-10 Volume 1 online
Did you know you can get FREE ICD 10 training online from the World Health Organization (WHO)? ICD10 training You can access the ICD 10 Volume 1 Tabular List HERE The ICD-10 Volume 3, also called the Index can be found online using the link below ICD-10_VOLUME 3_2006-Vol-3
Cycle Claims, Cycle Billing
Definition: A cycle claim is a claim which bills the payer for 30 days’ worth of tests, treatments, rehab, etc. Application and why is this type of claim asked for by either the client or the payer: The # 1 application for a cycle bill is for reoccurring treatment and/or testing, such as 3x a […]
What Does Accept Assignment Mean?
What Does Accept Assignment Mean? What does it mean to accept assignment on the CMS 1500 claim form – also called the HCFA 1500 claim form.? Should I accept assignment or not? What are the guidelines for accepting assignment in box 27 of the 1500 claim? These commonly asked questions should have a simple answer, […]