The Office of Inspector General (OIG) enforces theMedicarecertification process through unannounced inspections. The mission of the OIG is ‘to protect the integrity of the Department of Health and Human Services programs as well as the health and welfare of beneficiaries served by them. This statu...
Regardless of whether the contract is direct or assignment of commission, a street-level agent will receive commission from the carrier (either directly from the carrier or paid through the FMO) at an agreed upon industry rate. If the agent moves up or down the level hierarchy, commission ...
initial determination is entitled to a redetermination by the carrier or fiscal intermediary who made the initial determination. Such redetermination must be completed within 30 days of a beneficiary’s request. Beneficiaries may appeal the ...
C. PARTICIPATING MEDICAL GROUP agrees that, in the event a Member who is covered for workers’ compensation benefits by a workers’ compensation carrier affiliated with BLUE CROSS, seeks services for a work-related illness or injury, PARTICIPATING MEDICAL GROUP shall have the option to (a) provid...
Locum tenens physicians’ evaluation and management claims were ascertained using the Healthcare Common Procedure Coding System modifier code Q6,15 which identifies services furnished by locum tenens physicians and is applied in the Carrier File to the NPI of the regular physician for whom the locum ...
with a physician certification1and appropriate assessment and medical record documentation for each specific beneficiary, a physician may determine it is medically contraindicated for a beneficiary to leave the home if they have a confirmed or suspected case of COVID-19, or a condition that ...