New legislation authorized by Section 3024 of the Affordable Care Act will bring primary care teams into the homes of certain Medicare beneficiaries. Physicians and nurse practitioner teams will be testing a new service delivery model starting in 2012 that enables chronically ill patients to remain in their homes and receive services. For more information on the Independence at Home …

The new 5010 version of data interchange and ICD-10 Level II being tested and implemented by Medicare and Medicaid has caused the ICD-9-CM Coordination & Maintenance Committee to partially suspend any further updates to code sets.   ICD-9-CM and ICD-10 codes are usually updated annually. October 1, 2011 marks the last full update to ICD-9 code sets. On October 1, …

New health care electronic transaction standardized requirements are coming up fast. Testing for the new 5010 version of data interchange and ICD-10 Level II compliance begins January 1, 2011. The current version, 4010A will be accepted through December 31, 2011 but the new version 5010 will also be accepted by the Medicare & Medicaid systems. January 1, 2012 is the …

What is this exactly?  Technically speaking, it is the process of submitting fees for medical services to private, commercial, and government insurers for payment of such services, by completing a universal medical insurance claim, known as the HCFA1500.  As you can imagine, billing these types of services to regulated entities can get quite confusing.  It can either flow like a …

Understanding a denial from an insurance company is an important step in knowing how to file an appeal or reconsideration. First, re-check the claim and make sure all diagnostic and procedure codes were entered correctly, as well as the place of service. If the explanation code on the explanation of benefits (EOB) does not make sense, call the insurance company …