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Evaluation & Management (E/M) services are the majority of services billed by physicians and non-physician practitioners (NPP). Wisconsin Physicians Service (WPS) Medicare and the Comprehensive Error Rate Testing (CERT) contractor have identified documentation as the number one reason why Medicare either denies claims or requests refunds. So how do you know your medical billing... Read More
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There is conventional wisdome that says in-house billing is fraught with pitfalls. It's important to make sure your medical biller is both competent and compliant. Want to know the details according to an expert? Read: Why Doctors Should Outsource Their Billing
After reading this enlightening article, you might want more information about what to look for in a... Read More
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What is the carrier's responsibility regarding the fraud and abuse function?
The carrier's Fraud and Abuse Unit's primary role is to identify cases of suspected fraud and abuse, develop them thoroughly and in a timely manner, and take immediate action to ensure that Medicare Trust Fund monies are not inappropriately paid out and that any mistaken payments are recouped. Where appropriate,... Read More
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A provider, practitioner, or supplier may not routinely waive Medicare deductibles or co-payments in medical billing. One important exception to the prohibition against waiving co-payments and deductibles is that providers, practitioners, or suppliers may forgive the co-payment in consideration of a particular patient’s financial hardship. Any exception must address the special needs of a... Read More
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Cardiologists who interpret echocardiograms performed in the hospital setting must be careful to apply modifier 26 (Professional component) to the echocardiogram code in their medical billing. For example, the physician should report 93307-26 for a complete transthoracic echocardiogram performed on a hospital inpatient or outpatient. Modifier 26 tells the payor that the physician did not... Read More
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