Lump Sum Purchase of DME, Prosthetics, Orthotics

For injection codes with more than one possible TOS designation, use the following guidelines when assigning the TOS:
When the choice is P or 1,

• Use TOS P if the drug is administered through durable medical equipment (DME); or
• Use TOS 1 if the drug is administered in the office.

What is CMS 1500 Claim Form?

Claim Form CMS  :

In the 1960s there were a number of different claim forms and coding systems required by third-party payers to communicate information regarding procedures and services to agencies concerned with insurance claims. However, there was no standardized form for physicians and other health care providers to report health care services. Therefore, the American Medical Association (AMA) embraced an assignment in the 1980s to work with the Centers for Medicare & Medicaid Services (CMS; formerly known as HCFA), and many other payer organizations through a group called the Uniform Claim Form Task Force to standardize and promote the use of a universal health claim form.

Although many providers now submit electronic claims, many of their software/hardware systems depend on the existing 1500 Claim Form in its current image. Minor changes have been made to the form in order to accommodate the National Provider Identifier (NPI) as well as other identifiers.

The 1500 Health Insurance Claim Form answers the needs of many health payers. It is the basic paper claim form prescribed by many health plans for claims submitted by physicians and suppliers, and in some cases, for ambulance services.

Diagnosis Related Group {DRG} Meaning

DRG is a system to classify hospital cases into one of Approximately 500 groups, also referred to as DRG'S expected to have similar hospital resource use. They have used in US since 1983. There is more than one DRG system being used in the United States, but only the MS-DRG system is used by Medicare. 

tags  :
diagnosis code meaning,

Billing Terminalogy....

Medical Billing Terminalogy

1.Participating Providers

2.Non – Participating Providers

3.Capitation

4.Fee For Service (FFS)

5.Referral

6.Referral Authorization Number (RAN)

7.Pre-Authorization or Pre-Certification

8.Pre-Determination

9.Waiver of Liability

10.ABN ( Advanced Beneficiary Notice)

11.PayBack or Refund

12.Offset

13. Pre-Existing Condition

14.Waiting Period

15.COB ( Coordination of Benefits)

16.Deductible

17.Copay

18.Co-Insurance

19.Out of Pocket Expenses

20.Stop Loss Clause

21.Contract Maximum

22.Providers Identification Number

 

Medical Billing Structures (What is Medical Billing?)

What is Medical Billing?

Medical Billing is an essential part of the  
healthcare industry. Medical billing involves on submitting claims and follow up on requests to insurance companies from 
healthcare providers to receive payments 
for services rendered to patients.

In short “Managing Financial Transactions 
of the Provider”