Medical billing basic

Desk and Site Reviews All new IDTF applications shall receive (1) a thorough desk review, and (2) a mandatory site review prior to the contractor’s enrollment of the applicant and issuance of a billing number. The general purpose of both reviews is to determine whether the information listed on Attachment 2 of the CMS-855B is ... Read More

Centralized billing is a process in which a provider, who provides mass immunization services for influenza virus and pneumococcal pneumonia virus (PPV) immunizations, can send all claims to a single contractor for payment regardless of the geographic locality in which the vaccination was administered. (This does not include claims for the Railroad Retirement Board, United ... Read More

Hospitals This page provides basic information about being certified as a Medicare and/or Medicaid hospital provider and includes links to applicable laws, regulations, and compliance information. A hospital is an institution primarily engaged in providing, by or under the supervision of physicians, inpatient diagnostic and therapeutic services or rehabilitation services. Critical access hospitals are certified ... Read More

Railroad Medicare covers certain supplies if you have Medicare Part B and have diabetes. These supplies include: •    Blood glucose self-testing equipment and supplies •    Therapeutic shoes and inserts •    Insulin pumps and the insulin used in the pumps Blood Glucose Self-testing Equipment and Supplies Blood glucose self-testing equipment and supplies are covered for all ... Read More

Medicare uses an outpatient prospective payment system (OPPS) to pay certain outpatient claims. With this method of reimbursement, the Medicare payment is not based on the amount the provider charges; therefore, the billed charges generally do not affect the current Medicare prospective payment amounts. Billed charges usually exceed the Medicare payment amount; therefore, a Medicare ... Read More

Repetitive Scheduled Non-Emergent Ambulance Transport The Centers for Medicare and Medicaid Services (CMS) will implement a 3 year prior authorization program for repetitive scheduled non-emergent ambulance transports in the states of New Jersey, Pennsylvania, and South Carolina based on where the ambulance company is garaged. A repetitive ambulance service is defined as medically necessary ambulance ... Read More