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When Should you Issue an Advance Beneficiary Notice?

You must issue an Advance Beneficiary Notice (ABN) when you expect Medicare may deny payment for an item or service because:

When You Must Issue an ABN (Advance Beneficiary Notice)

You must issue an Advance Beneficiary Notice (ABN) when you expect Medicare may deny payment for an item or service because:

  • It is not considered reasonable and necessary under Medicare Program standards;
  • The care is considered custodial;
  • Outpatient therapy services are in excess of therapy cap amounts and do not qualify for a therapy cap exception;
  • A beneficiary is not terminally ill (for hospice providers only); or
  • A beneficiary is not homebound or there is no need for intermittent skilled nursing care (for home health services only).

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How to Handle the Physician Credentialing Process with Ease

Credentialed physicians

Physician Credentialing – A Necessity

A couple of decades ago healthcare professionals considered physician credentialing as the procedure for enrolment with an insurance company’s preferred provider network.  Now a days, it is mandatory than ever for physicians and healthcare providers including nurses, chiropractors, psychologists, counselors, LCSW’s and many others to be in network with insurance companies. This is a necessity because most people in the United States have health insurance than ever before.  And it is necessary because people today demand their healthcare physicians accept their insurance.  Honestly saying, if a physician is not in network with a patient’s health insurance plan, the provider is at risk of losing that potential patient to a competing practice. (more…)

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Watch for Bundles

Codes used for Percutaneous vertebroplasty include the two procedures frequently performed during the same session—imaging guidance and bone biopsy therefore you might not code individually for them at the same level. 

Codes used for Percutaneous vertebroplasty include the two procedures frequently performed during the same session—imaging guidance and bone biopsy therefore you might not code individually for them at the same level.  If the medical provider performs bone biopsy at a level not addressed by the vertebroplasty, you may report biopsy alone with the 59 modifier appended to indicate the separate locations of the two procedures. (more…)

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