84 articles matching “billing guide”.
Showing 25 to 48 of 84
UB-04 claim form elements including Type of Bill, condition codes, and occurrence codes, revenue code categories for hospital departments and services, inpatient IPPS DRG payment calculation with CC/MCC impact, outpatient OPPS APC reimbu...
WC billing vs. commercial insurance, separate payer, no patient cost-sharing, state-specific fee schedules, state WC fee schedule structure and rates, utilization review authorization with evidence-based treatment guidelines, claim submi...
How clearinghouses translate and route 837P/I electronic claims to payers, perform claim scrubbing, return 835 ERA and 277 claim status transactions, HIPAA EDI transaction standards overview, ERA and EFT enrollment for automated payment...
TRICARE Prime, Select, For Life, Reserve Select, and Young Adult program options, network vs. non-network authorized provider billing, regional contractor claim submission for East and West regions, TRICARE For Life Medicare crossover co...
Fee-for-service vs. Medicaid managed care billing differences, EVS eligibility verification and monthly verification requirements, FQHC and RHC Prospective Payment System billing, Medicaid MCO claim submission and enrollment, and most co...
Credentialing vs. payer enrollment distinction, CAQH ProView profile maintenance and authorization, Medicare PECOS and CMS-855 enrollment process, commercial payer enrollment timelines by plan, retroactive billing strategies for the enro...
FQHC PPS encounter rate billing (G0466/G0467), qualifying visit requirements, RHC all-inclusive rate structure, Medicaid wrap-around payment reconciliation, sliding fee scale compliance, and telehealth for FQHCs.
CDM structure (charge code, CPT/HCPCS, revenue code, charge amount), annual update cycle driven by CPT changes and OPPS updates, common CDM errors and billing impact, price transparency compliance, and CDM audit methodology.
FESS endoscopic sinus surgery codes by sinus type, tonsillectomy age-specific codes, flexible laryngoscopy billing, hearing evaluation and audiology codes, and in-office ENT procedure capture best practices.
Psychiatric evaluation codes 90791/90792, psychotherapy time-based codes, E&M plus psychotherapy add-on billing (90833/90836/90838), interactive complexity add-on 90785, and mental health parity law compliance.
90-day global period management, fracture care code rules, joint replacement bundled payments, spinal surgery component coding, and arthroscopy bundling rules in orthopedic billing.
Drug administration CPT hierarchy rules, HCPCS J-codes for drug billing, chemotherapy vs. non-chemotherapy administration code distinctions, and drug waste billing with JW modifier.
Anesthesia billing uses the base units plus time units times conversion factor formula. This guide covers anesthesia CPT code base unit values, qualifying circumstances 99100-99140, anesthesia modifiers AA QZ QX QK and AD, medical direct...
Emergency medicine billing uses ED-specific E&M codes 99281-99285 based solely on Medical Decision Making with no new vs. established distinction, critical care time billing with 99291 for first 30-74 minutes and 99292 add-on for each ad...
Home health billing covers the Patient-Driven Groupings Model PDGM 30-day payment periods, OASIS-E assessment coding, homebound status eligibility documentation, physician plan of care face-to-face certification, Notice of Admission NOA...
Cardiology billing covers echocardiography TC/PC split 93306, stress testing 93015-93018, nuclear SPECT 78451-78452, cardiac catheterization 93454-93461, PCI codes, EP ablation 93653-93657, ICD implant documentation, and cardiology prior...
Lab billing covers the Medicare Clinical Laboratory Fee Schedule PAMA rates, CLIA certificate types, common lab CPT codes 80047-89398, molecular diagnostics and NGS coverage, ABN requirements with Modifier GA for non-covered tests, and s...
Urology billing covers cystoscopy codes 52000-52356 including ureteroscopic procedures, prostate procedure coding for TURP 52601 and robotic prostatectomy 55866, lithotripsy ESWL 50590 and PCNL 50080-50081, urodynamics 51725-51797 with T...
Ophthalmology billing covers cataract surgery codes 66984 and 66982, premium IOL patient billing, intravitreal injection 67028 with anti-VEGF J-codes and Modifier JW drug waste, glaucoma procedure coding including MIGS 66183, OCT 92134...
2019 skin biopsy code updates (11102-11107), lesion excision size and margin documentation, Mohs surgery stage billing, skin destruction counting rules, and phototherapy/biologic administration coding.
Gastroenterology billing covers colonoscopy CPT codes 45378-45398 including polyp removal by snare and hot biopsy forceps, screening vs. diagnostic colonoscopy ACA preventive benefit distinction, EGD codes 43235-43270 with biopsy and abl...
Neurology billing covers EEG codes 95812-95830, EMG and nerve conduction studies 95860-95913, botulinum toxin injection codes 64612-64647 with J-codes J0585-J0588 and NDC documentation, lumbar puncture 62270, evoked potential studies, an...
Timed vs. untimed PT codes, the 8-minute rule for unit calculation, Medicare therapy threshold and KX modifier attestation, evaluation complexity levels, and group vs. individual therapy billing rules.
Pain management billing covers epidural steroid injection codes 62320-62327 and transforaminal 64479-64484, facet joint injections and RFA 64633-64636, spinal cord stimulator implant 63650-63685, imaging guidance bundling rules, and urin...
