13 Jul Success in Medical Billing for Medicare Claims
Medical practices often rely upon Medicare to pay for services rendered. In order to receive payments from Medicare, those handling the medical billing and coding must follow very specific procedures. If procedures are not adhered to, then payment will not be made. That being the case anyone who handles medical billing and coding in relationship to Medicare claims is best served by proceeding in a manner that is designed to address all aspects of the medical claim process.
Often those best suited for dealing with the submission of such claims are medical billing and coding companies, which have the resources to work with Medicare’s bureaucracy.
Specifics: No Violations Allowed
With a claims processing methodology that is highly refined, there’s little to no leeway for those submitting Medicare claims. Along with adhering to National Correct Coding Initiative (NCCI) edits, Medicare has a very strict protocol for claims.
They disperse payments according to a length of time that has been predetermined. The good news is that they do pay on time and usually through electronic fund transfer (ETF) as long as all paperwork is properly filled out. Never expect Medicare to adapt to the manner in which you do things. Follow their prescriptive instructions to the letter, including any criteria for coding as mandated by HCPCS Level II Coding Process & Criteria.
The Centers for Medicare & Medicaid Services (CMS) is charged with setting Medicare criteria for the nation. However, CMS does not directly handle the processing of claims. Instead, they contract with regional companies, which are known as Medicare Administrative Contractors (MACs). MACs are charged with processing Medicare claims, and, if need be, they may adopt or develop specific polices regarding claims if no procedure exists nationally or if there is a need to define more specifically an already existing national coverage determination.
When making a decision, the MAC utilizes the Medicare Program Integrity Manual, which offers guidelines for the development of a local coverage determination (LCD). Coding software has been developed that can identify these LCDs. However, no MAC can agree to cover a procedure or service that is not presently approved by CMS. Such services must be paid for through an agreement signed ahead of time by the patient.
The patient would sign what is called an advanced beneficiary notice (ABN). If the medical professional does not offer an ABN or if the patient does not sign it and the services or procedure that are not covered by Medicare are rendered, the patient is not responsible for payment.
Professional Services Useful
In dealing with Medicare claims, many healthcare practices find the services of a medical billing and coding company to be very useful. Such a company would not only understand all of Medicare’s procedures and guidelines, but they would also be current on any regional coverage polices as determined by the MAC.
In addition, a company that has a history of working with regional MACs can often anticipate any issues that may affect a claim and can adroitly correct any problems associated with a claim that has been rejected.
MPMR is the best medical billing company in the nation, offering expert services to both individual medical practices along with ambulatory surgery centers. Along with the medical billing and coding, MPMR provides practice management consulting as well to help increase efficiencies and revenue.
Call (951) 757-2056 today!