What is Medicare Part A? Medicare Part A is inpatient hospital insurance. This part of Medicare covers some of your hospital, inpatient nursing facility, and hospice costs. Remember that Medicare Part A does not cover any of the treatments or procedures you receive while in a hospital or nur...
Original Medicare (Part A and Part B) allows you to see any doctor you choose. However, not all providers handle billing in the same way. Medicare assignment provides a list of rates that Medicare will pay for the healthcare services it covers. If your provider participates in Medicare ass...
Medicare Diabetes Screening BillingMedicare Part B covers patients with certain diabetes risk factors or diagnosed with pre-diabetes. But note that patients previously diagnosed with diabetes aren’t eligible for diabetes screening benefits. Medicare covers 1 screening every 6 months for patients diagnosed...
The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every po
Initial and ongoing requirements for a beneficiary to be eligible to receive hospice services under the Medicare Hospice Benefit include: Eligibility: A patient must be eligible for Medicare Part A Informed consent: The beneficiary must agree that they wish to receive "palliative, not cu...
in which all services that are related to the terminal illness are covered up to 100 percent by Medicare Part A. Care that is unrelated to the terminal illness continues to be covered by Medicare Parts A and B, with all normal rules applicable (e.g., co-payments, coverage guidelines, and...
Billing Guidelines Wound Care (CPT Codes 97597, 97598 and 11042-11047) 1. Active wound care procedures are performed to remove devitalized and/or necrotic tissue to promote healing. Debridement is the removal of foreign material and/or devitalized or contaminated tissue from or adjacent to a tra...
Billing procedures with Medicare as a secondary payer When you have Medicare as your secondary payer, the billing process can become a bit more intricate. Here’s an overview of how billing works when Medicare is the secondary payer: 1. Initial Claim Submission: Your healthcare provider submits...
Ensure proper documentation and billing for residents. Feedback Management Investigate and resolve all feedback and complaints received pertaining to rehab staff. Assist in any investigation that is escalated to HQ. Escalate any unfavorable and unresolved feedback to HQ. ...
Review the 2026 CMS Medicare Advantage and Part D Advance Notice as we break down proposed measure and policy changes from a quality perspective. Watch Webinar Breaking down HEDIS public commentRegister for our next Quality Decoded webinar on 3/6 Register Now Fraud, Waste, and Abuse FWA Insig...