Need Assistance With Your Ambulatory Surgical Center?

Medicare Claims Processing Manual for Ambulatory Surgical Centers Chapter 14: 30 & 40 produced by the CMS Covers the following topics:

• Rate Setting Policies
• Where to Obtain Current Rates and Lists of Covered Services
• Payment for Ambulatory Surgery
• Payment to Ambulatory Surgical Centers for Non-ASC Services
• Wage Adjustment of Base Payment Rates
• Payment for Intraocular Lens (IOL)
• Payment for Terminated & Multiple Procedures
• Payment for Extracorporeal Shock Wave Lithotripsy (ESWL)
• Offset for Payment for Pass-Through Devices Beginning January 1, 2008
• Payment When a Device is Furnished With No Cost or With Full or Partial Credit Beginning January 1, 2008
• Payment and Coding for Presbyopia Correcting IOLs (P-C IOLs) and Astigmatism Correcting IOLs (A-C IOLs)

To download and view the full CMS ASC Claims Manual on Rate-Setting Policies & Payment for Ambulatory Surgery click the following link: http://ww2.medicalreimbursementinc.com/l/3732/2012-06-08/2746tl (PDF)

Ambulatory Surgical Center Payment Updates to be Implemented in July 2012

Changes to the ASC Payment System and billing instructions for various payment policies to be implemented in the July 2012. An ASC update guide produced by the CMS highlights the following:

• Changes in Manual Instructions
• Funding
• For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs) and/or Carriers
• For Medicare Administrative Contractors (MACs)
• New Category III CPT Codes that are Separately Payable Under the ASC Payment System Effective July 1, 2012
• Instructions for Device Pass-Through Category C1840
• Billing for Drugs, Biologicals, and Radiopharmaceuticals
• Drugs and Biologicals with Payments Based on Average Sales Price (ASP) Effective July 1, 2012
• New HCPCS Codes for Drugs and Biologicals Separately Payable under the ASC Payment System Effective July 1, 2012
• New HCPCS Codes Effective July 1, 2012 for Separately Payable Drugs and Biologicals
• Adjustment to the Payment Indicator for Certain HCPCS Codes Effective April 1, 2012
• Coverage and Business Requirements
• Provider Education

To download and view the full guide, please click the following link: Ambulatory Surgical Center Payment Updates to be Implemented in July 2012

Managing Underpayments in Medical Billing

An article, "Managing Underpayments in Medical Billing: Getting Every Penny You Deserve" published by Kareo, recommends the following tips on how to manage your underpayments

1. Know what you should get paid
2. Seek other sources
3. Deploy alternate strategies
4. Establish a process to ensure payments are correct
5. Examine remittances
6. Evaluate staff motivation
7. Recognize that underpayments may not come from the insurance company

To view the full article and the tips in further detail, please go to our resources page located here: Medical Reimbursement, Inc - Current News Articles

How to Use the Medicare Coverage Database

Do you know what to use to determine Medicare coverage?

A fact sheet was produced by the Centers for Medicare and Medicaid Services highlighting how to use the Medicare Coverage Database.

The document addresses the following topics:

• What is the Medicare Coverage Database (MCD) ? 
• Why would a Health Care Professional, Supplier, or Provider Use the Coverage Database?
• Background: Medicare Coverage and Coverage Determinations
• How Up-to-Date is the MCD?
• How to locate, navigate, and search the MCD 
• Using the Indexes & Reports Feature - National & Local Coverage
• Tips and how to use MCD Downloads
• Additional Resources on the MCD
  
  To download and view the document on the MCD, please go to the following link: How to Use the Medicare Coverage Database (PDF)

The National Provider Identifier (NPI) What You Need to Know

According to the Centers for Medicare and Medicaid Services, The National  Provider Identifier (NPI). The Administrative Simplification provisions of the Health  Insurance Portability and Accountability Act  of 1996 (HIPAA) mandated the adoption of  a standard, unique health identifier for each  health care provider.

To further explain the process, a short fact sheet highlighting the topics below was created by the Centers for Medicare and Medicaid Services:

• What is an NPI?
• Benefits
• Eligibility
• Who Must Obtain the NPI?
• What the NPI does and does not do
• Who Cannot Receive an NPI?
• National Plan and Provider Enumeration System (NPPES) 
• NPI Registry
• NPPES Downloadable File
• Healthcare Provider Categories
• How to apply for an NPI
• Additional Website Resources

To view and download the full fact sheet, please go to the following link: National Provider Identifiers (NPI): What You Need to Know

Global Surgery Fact Sheet

Are you billing the necessary services before, during, and after a surgical procedure?

The Centers for Medicare and Medicaid Services produced a Global Surgery billing guide with guidance on how to properly bill the global surgery package, the fact sheet highlighted the following:

• Definition of a Global Surgical Package
• FAQs
• Is the global surgery payment restricted to hospital inpatient settings?
• How is Global Surgery classified?
• Where can I find the post-operative periods for covered surgical procedures?
• What services are included in the global surgery payment?
• What services are not included in the global surgery payment?
• How are minor procedures and endoscopies handled?
• Global Surgery Coding and Billing Guidelines
• Pre-operative Period Billing
• Day of Procedure Billing
• Post-Operative Period Billing
• Special Billing Situations
• Resources Pages with links to additional resources

To download and view the guide, please go to the following link: Global Surgery Fact Sheet

How to Use The National Correct Coding Initiative (NCCI) Tools

Are you familiar with the NCCI (National Correct Coding Initiative) and how to tell if your coding is up to par?

The guide, "How to Use The National Correct Coding Initiative (NCCI) Tools" Produced by the Centers for Medicare and Medicaid Services highlights the following topics:

• What is the National Correct Coding Initiative (NCCI)
• Who should use the NCCI Web Page, Tables, and Manual
• How Up-to-Date are the NCCI Tables
• Background: NCCI Edits
• Using The NCCI Tools 
• Looking Up 2 Types of Code Pair Edits  
• How to Use the Code Pair Tables 
• Looking up the 3 Provider-Types of Medically Unlikely Edits (MUEs)
• Using the NCCI Policy Manual For Medicare Services
• Resources page with additional websites
• How to Filter NCCI data tables

To download and view the full guide, please go to the following link: NCCI Tools