Answer: Medicare Part A covers inpatient hospital care, skilled nursing facility care, and home health services for homebound patients. All individuals receive Part A benefits when they turn 65, but Medicare Part B benefits are elective and require payment of monthly premiums. Therefore, many people delay enrolling in Part B if they are still working
Answer: No. Medicare Advantage Plans (MAP) are not supposed to reimburse patients for services by unenrolled providers even if the MAP offers out of network. That said, MAPs sometimes erroneously reimburse patients. If your patient submits a claim and is reimbursed, that doesn’t necessarily mean it is ok. Medicare patients should always go to Medicare
11/11/2022: This Client Alert_RE CMS 1490S form instructions & sample form_2022-11-11 provides new instructions on how patients can submit a claim to CMS on form 1490S just to get a denial so a secondary or supplemental payer will reimburse claims they cover. Follow these new instructions instead of the instructions in the 9/15/2022 webinar.
Client Alert for Cash Practices RE: CMS 1490S form Read More »
Beginning Jan. 1, 2020, private practices have to use the CQ modifier (for PTAs) and CO modifier (for COTAs) on each CPT code where the PTA or COTA provided more than 10% of the service independent of the PT or OT. For t15-minute timed codes, this equates to 2 minutes or more of the time.
New CQ and CO modifiers for PTAs and COTAs Read More »
Question: I need to work at another private practice to supplement my income while building my cash practice. The practice sees and bills Medicare under the practice’s NPI number. They will require me to enroll as a Medicare provider to treat their patients. Will this cause any issues for my cash practice? Will I have
Advice on Superbills When you agree to see a Medicare beneficiary who has elected to pay you cash instead of seeing a Medicare enrolled provider you are accepting some risk that the patient may try to submit your receipts to Medicare for reimbursement or to obtain a denial for a Medicare Supplemental Plan. If the patient
Advice on Superbill Content Read More »
Do you need to know what the rules are for getting PT, OT and other services covered under Medicare, including what all the billing, coding and documentation rules are? The Medicare Benefit Policy Manual is where you need to look. PT, OT and Speech policies are in section 220 of Chapter 15, available here.
Medicare Rules for PT Benefits Read More »
On March 12, 2013, Judy Holder from FOTO gave an excellent presentation to our Practice Management Network/My Legal Counsel Members on the Medicare G-Code Reporting requirements and how FOTO can help. The presentation was recorded . . . .
Medicare G-Code Reporting with FOTO – recorded presentation posted Read More »
If you missed PQRS: Everything you need to know in 1 hour! by Danielle Haggerty on Tuesday, Jan. 8, the webinar was recorded and is now available.
PQRS Recorded Webinar and Documents from 1/8/2013 now available! Read More »
