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5 Medical Billing Questions You Should Know the Answers
ABOUT THIS BLOG A place for physicians and other healthcare RCM stakeholders to share and discover
by Harold Gibson on Tue, Jan 06, 2015 Share
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information about everything related to medical billing and ways to increase revenue.
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Founded in 2002, M-Scribe is a full service
Revenue Cycle Management
Staying well informed on the latest changes
(RCM) Company. We provide all types of
in medical billing will ensure your practice
claims billing services integral to healthcare
runs as effectively as possible with the
delivery system.
fewest amount of denied claims. Unfortunately this industry can change quickly, so you really have to make an effort to not just get on top of all the knowledge but also to stay on top of new information. It can become quite difficult to sort through all of the nonsense sent your way, and since some information is more important than others, we have put together this list of the 5 medical billing questions you should know the answers to in order to perform the task successfully.
Question 1: Who can bill claims using the CMS-1500? Answer: Any non-institutional provider and/or medical supplier may use the CMS-1500 for medical
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billing purposes. Some examples of providers and suppliers that may qualify include:
Name*
Ambulance services Phone Number
Certified registered nurse anesthetists Clinic nurse specialists Clinic psychologists and social workers
Email*
Nurse midwives Nurse practitioners Physician’s assistants
Persona
Providers of clinical diagnostic laboratory services
- Please Select -
Providers of home dialysis supplies and equipment
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Question 2: What refers to Medicare benefits when Medicare is not the primary insurance? Answer: Medicare Secondary Payer (MSP) is the medical billing term used to describe benefits that are available when Medicare is not the primary insurance carrier. Medicare is the primary insurance when the patient is 65 or older and: Has a small group plan through their own or a spouse’s employer Has insurance made available through a retirement plan Medicare is also the primary insurance when an individual is disabled and has a small group plan through their own or their spouse’s employer, regardless of age. Question 3: Who is the payer of last resort? Subscribe to RSS feeds Answer: Medicaid is always the payer of last resort when the patient also has coverage under other health plans. Medical providers must notify Medicaid of any third party insurance information they are aware of, in addition to informing them as to any payments they receive on behalf of the recipient.
MOST READ Medical Billing Intricacies: What are Modifier
Question 4: What set of questions are asked to determine MSP situations?
Codes?
Answer: The Medicare Secondary Payer Questionnaire is given to determine MSP situations. The
Common Reasons Medical Billing Claims Get
questions contained in this questionnaire should be asked during each admission for those who have
Rejected
other insurance coverage outside of Medicare. Doing so will also enable providers to determine
Inpatient Coding Vs Outpatient Coding: Medical
whether or not other payers are primary or secondary.
Coding Explained 6 Key Steps of a Successful Medical Billing
Question 5: Which procedure codes are most often used by physicians rendering
Process Intensive Outpatient Program - IOP Billing
services?
Guidelines Explained
Answer: CPT codes, which have been developed by the American Medical Association (AMA) in order to identify the most common medical billing codes used by physicians when treating patients.
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The most frequently used procedure codes are those relating to medical evaluation and management,
Medical Billing (224)
a few of which include:
Medical Coding (112) ICD-10 (98)
99201-05 New Patient Office Visit
EHR (75)
99211-15 Established Patient Office Visit
Medical Documentation (50)
99281-85 Emergency Department Visit
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99241-45 Office Consultation It is essential for everyone who does medical billing on regular basis to know the answers to these five questions. It is very critical for medical billers to have a strong working knowledge of each of these situations. If you were unable to answer all these questions correctly, you may read the
POSTS BY MONTH December 2017 (6) November 2017 (7)
whitepaper or feel free to contact us to get more information.
October 2017 (9) September 2017 (9) August 2017 (9) July 2017 (7) June 2017 (8) May 2017 (10) April 2017 (8) March 2017 (5)
Topics: Medical Billing
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About The Author Harold Gibson Harold R Gibson is the Chief Financial Officer at M-Scribe - a healthcare revenue cycle management company. Harold is an accomplished healthcare prof... read more
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