THERAPY SERVICES (PT, OT, SLP) (L32710)
Coverage GuidanceCoverage Indications, Limitations, and/or Medical NecessityNotice: It is not appropriate to bill Medicare for services that are not covered (as described by this entire LCD) as if they...
View ArticleHow to submit claims for physician or NP or Physical or Occupational...
For claims submitted by a physician or NPP:• Services performed by non-employees or those not under a physician’s or NPP’s direct supervision are not covered. • Services not relating to a written...
View ArticleProvider not participated with Medicaid MCO - Would he get reimbursement?
Payments to Managed Care OrganizationsRecipients are linked by their MCO to a primary care physician or clinic. All MCO-enrolled recipients are provided an identification card by their respective MCO....
View ArticleSpecific Modality Guidelines G0283, 97012,97016,97018, 97022,97036, 97028,...
The following clinical guidelines pertain to the specific modalities listed.G0283 – This modality includes the following types of electrical stimulation: • Transcutaneous Electrical Nerve...
View ArticleMedicaid HMO non covered service list
MCO Excluded Services(Fee-For-Service)The MCO’s are responsible for providing all Medicaid covered services excluding the following, which are paid fee-for-service by Medicaid:Abortion Services – MCO’s...
View ArticleGeneral Guidelines for Therapeutic Procedures 97110, 97112, 97113, 97116,...
• Therapeutic procedures are procedures that attempt to reduce impairment and improve function through the application of clinical skills and/or services.• Use of these procedures requires that...
View ArticleHumana claims , overpayment, appeal address - time limit
Claim and encounter addressesTo decrease administrative costs and improve cash flow, clinicians and facilities are encouraged to use electronic claim submission whenever possible.When it is necessary...
View Articlewhat is self referral and what are the covered service under self referral?
Self-Referral ServicesSelf-referral services are defined in the HealthChoice regulations as “health care services for which under specified circumstances the MCO is required to pay without any...
View ArticleCPT code 43659, 43843, 43999 and Group 1 codes
Bariatic Surgical Management of Mobid Obesity Coding InformationBill Type CodesContractors may specify Bill Types to help providers identify those Bill Types typically used to report this service....
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Can we request Medicare early or immediate offset of a demanded debt?
A. Yes. When you receive an overpayment demand letter indicating a refund is due, you can request immediate offset of the debt in writing.The immediate recoupment process allows providers to request...
View ArticleDocumentation Requirements for PT/OT services
1. All documentation must be maintained in the patient's medical record and available to the contractor upon request.2. Every page of the record must be legible and include appropriate patient...
View ArticleWhat is retrospective billing ?
Q: What is the difference between the effective date and retrospective billing date?A: The effective date is the later of the following two dates:• The filing date of an enrollment application that was...
View ArticleHealthchoice Medicaid HMO Timely filing limit and claim submission address
BILLING INFORMATIONProviders must bill on the CMS-1500. Claims can be submitted in any quantity and at any time within the filing limitation.Filing Statutes: Claims must be received within 12 months of...
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When provider need to notify Medicare - change in address, ownership,...
Q: What does Medicare consider to be “reportable event” (with regard to the provider/supplier’s enrollment record)? How long does a provider/supplier have to notify their Medicare administrative...
View ArticleNon-Invasive Peripheral Venous Studies ( L34714 ) Coverage Guidance
Compliance with the provisions in this policy may be monitored and addressed through post payment data analysis and subsequent medical review audits.Vascular studies include patient care required to...
View ArticleCPT code 93965, 93970, 93971 and G0365 AND covered DX
Non-Invasive Peripheral Venous Studies Coding InformationBill Type CodesContractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of...
View ArticleMedicare HMO annual visit CPT code G0402, G0438 and G0439 coverage
Medicare Advantage Program Coding for Welcome to Medicare and Annual Wellness VisitsIMPORTANT REMINDER: Florida Blue, as a Medicare Advantage plan with four contracts with the Centers for Medicare...
View ArticleSacral Nerve Stimulation Coverage Guidance
Sacral nerve stimulation is defined as the implantation of a permanent device that modulates the neural pathways controlling bladder function. This treatment is one of several alternative modalities...
View ArticleWhat we can do in IVR - What are information need to use IVR
Interactive voice response (IVR) system capabilitiesThe IVR system provides automated information on claims, benefits and more, 24 hours a day, seven days a week.Call the number on the back of the...
View ArticleSacral Nerve Stimulation Coding Information CPT code 64561, 64581, A4290
Bill Type CodesContractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not...
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