From the first minute a patient arrives at a doctor’s office you have to know whether he/she is a new patient. A new patient is the one who has not been seen by the physician or any physician in that specialty group within the last three years.
These new visits are reported using […]
In some states Medicaid places its insurance plans in HMO. These plans require preauthorization services.
These services could be one or all of the following:
Effective admissions Admission diagnosis and outline of treatment plan. Reason for inpatient treatment. Admission diagnosis and outline of treatment plan Preparation days more than 1. Reason why […]
Here are the most common types of managed care plans. It is important to know them because each insurance plan has specific billing and coding methods.
EPO: Exclusive provider Organization.
HMO: Health Maintenance Organization.
IPA: Independent Practice Association.
POS: Point Of Service.
PPO: Preferred Provider Organization.
Managed Care Plan Co-pay/Deductible Payment Authorization Required HMO […]
Eligibility consists of an on-the-job injury or a condition that is a direct result of the individual’s job. The law states that a waiting period must elapse before benefits are payable. This period is different from state to another. Classifications […]
This notice must be completed, signed, and dated, also the modifier GA must be used when sending the […]
The following table explains Medicare covered and non-covered services in Medicare Part B.
Medicare Secondary Payor
In some cases there is a primary insurance that should pay before billing Medicare. In these cases, Medicare is the secondary insurance and another company is the primary insurance. […]
CMS 1500 is the form used to submit claims.
Deductibles are often $100 for physician services and outpatients.
Allowable amount will vary according to the plan, but we usually see the allowable amount 80%.
A surgical financial disclosure form is required for all […]
Tricare differs from other insurance companies. Tricare is a health care program for:
Eligible survivors of members of the uniformed services. Active duty members of the military and qualified family members. Champus eligible retirees and qualified family members.
Tricare consists of three main plans:
Tricare’s fiscal year for collecting deductible runs […]
Aetna is one of the most important insurance carriers in the United States and generally, billing an insurance company is different from one to another. In this post I got some of the medical office codes that Aetna covers for PCP (Prime Care Physician.)
Subscribe to MedicalCoder Mailing List
Most Popular Articles
Most used Medical Billing Modifiers
3 Important Reasons to Use the Clearinghouse to Submit Medical Claims
PCP Covered Office Lab Procedures with Aetna
Hospice and Skilled nursing
What To Do If Your Claim Is Denied For a Pre-Existing Condition?
Medical Billing Terms you need to know
Chart: How To Code Cardiac Catherization?
Major Differences between Medical Biller & Medical Coder
Medicare Advantage Plans
What to do if you received a denial for untimely filing?
- Most used Medical Billing Modifiers
TagsAetna Aging ECHO EKG follow up Humana ICD-9 ICD-10 insurance managed care medicaid medical billing medical billing modifiers medical claims medical codes medical coding medical facility medical insurance medical modifiers medical terminologies medical terms Medicare Texan Plus Tricare United Healthcare workers compensation