Medical Billing Blog: Section - Medicare

Archive of all Articles in the Medicare Section

This is the archive containing links to all articles written in the Medicare section of our blog.

Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.

Flu Season is Nearly Upon Us… Medical Coding for Influenza Vaccine

Since Flu season is rapidly approaching, we decided to take a look at the medical codes that are utilized for billing of vaccine shots.   First of all, what exactly is the Flu? Flu is short for Influenza, which is a contagious respiratory disease caused by the Influenza virus. Influenza virus infects the nose, throat, and in a rare condition the lungs. The symptoms can be mild to severe. The most common influenza symptoms include high fever, sore throat, headache, coughing, runny nose, muscle and joint pain, and fatigue (body weakness). This virus generally occurs during the winter months. Influenza is a serious health condition that can lead to pneumonia.

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CMS adds 85 more Medicare telehealth services and codes

Becker’s Hospital Review posted that CMS issued various regulatory changes on March 30 to further support hospitals’, physicians’ and other healthcare organizations’ capabilities during the COVID-19 pandemic, including expanding Medicare coverage of telehealth visits.  On March 17, the Trump administration announced CMS will temporarily pay clinicians to provide telehealth services for beneficiaries during the pandemic. CMS is now expanding Medicare coverage of 85 additional services provided via telehealth, including emergency department visits and initial nursing facility and discharge visits.  Here are the 85 additional services, and their respective codes, that CMS will cover when provided via telehealth through the duration of the pandemic:  1. 77427: radiation management 2. 90853: group

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ICD-10 for Substance Abuse & Mental Health Providers

The Substance Abuse and Mental Health Services Administration (SAMHSA) has published a new fact sheet designed to help mental health and substance abuse service providers make the transition to the new International Classification of Diseases, 10th Edition (ICD-10) code sets. ICD-10 will affect all diagnosis and inpatient procedure coding for everyone involved in mental health and substance abuse healthcare under HIPAA. However the change to ICD-10 does not affect CPT coding for outpatient procedures. All services provided for either substance use or mental disorders are subject to HIPAA standards; therefore, all mental health and substance abuse providers must shift to ICD-10 once it becomes effective on October 1st. SAMHSA’s new

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New HCPCS Medical Billing Tool

Your practice should know where to look for medical billing changes each year. When dealing with HCPCS consolidated billing, many billers become confused about what codes are excluded from this type of billing. Before allowing your staff members to do medical billing, be sure they know where to look for answers to their coding questions. The source to find consolidated HCPCS medical billing codes is no longer in the Centers for Medicare & Medicaid Services’ Skilled Nursing Facility Help File. Since September 25, 2005, CMS has tried to steer medical billing staff members away from this file. Now, however, it is more important to do so. A new website has

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Update Your Reporting Method To Medicare

Update Your Reporting Method To Medicare or Face Denials Times are changing when performing electronic medical billing to Medicare. Beginning on August 1, 2005, noncompliant electronic claims billed will be denied. These billed medical claims must be compliant with the Health Insurance Portability and Accountability Act (HIPAA). Currently there is a medical billing contingency plan in effect that does accept these noncompliant claims, but that will soon end. In order to ensure the most efficient payment possible, submitting compliant electronic claims is recommended. Otherwise, the Centers for Medicare & Medicaid Services will send the claim back to you unprocessed and with no payment. To get medically reimbursed for this billing,

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Ready for your Medicare Site Visit?

Securing a Medicare provider number is a priority for any new practice. Properly submitted electronic Medicare claims can turn to cash in 21 days and can help establish a predictable cash flow. Part of the approval process includes a site visit and presentation of “QID’s” such as #14120: DOCUMENTED BILLING PROCEDURES that states “Sound practice management provides for defined billing procedures and reference materials as a component of increased accuracy.” When you engage a billing and coding company make sure the support team you choose is familiar with all Medicare procedures including the all-important site visit and the information required and presented during the visit. A company that is familiar

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Getting Those "Q" Modifiers Right For Medicare

Remember when medical billing used to be a simple affair of matching the procedure done with a couple of medical billing codes to describe what was done, attaching your documentation and then submitting your medical billing claim for reimbursement? Now we have codes for codes and modifiers and the need to when to bundle and when to not bundle with the goal being fair reimbursement for procedures done. Modifiers cause a lot of confusion for many medical billers. One such confusing modifier that is worth clarifying is Q6. This applies to Medicare medical billing claims only, but in a nutshell when one of your staff physicians takes a leave of

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Report – HHA’s and Hospices Are Billing Medicare Accurately

A recent report showed that HHA’s (home health agencies) and hospices are billing Medicare on an accurate level according to a report compiled by the CMS’ Comprehensive Error Rate Testing. The report showed that HHAs had a 1.4 percent error rate and hospices a 1.0 percent error rate in the November CERT report, which covers claims from April 2006 to March 2007. DME (durable medical equipment) suppliers had a wide range of error rates broken out by supplier type. The lowest was 0.6 percent for a medical supply company with prosthetic/orthotic personnel certified by an accrediting organization while the highest was a whopping 51 percent for “unknown supplier/provider” where it

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Medicare Website Updated to Make Medical Billing Information Easier, Faster to Find

Due to high usage and informational usage by the medical billing community at large, the Medicare website has revamped certain areas to make their site easier to search and access. When a medical biller is looking up information, at the Medicare coverage site located at, it is now easier than ever to search for the coverage limitations and other required information that you need. The page is now set up to ask if the biller is asking for a local or national coverage determination to avoid confusion and misinformation that was previously disseminated as there are certain differences between local and national coverages for certain procedures. Medical billers may

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