Billing
Tips for faster turnaround times for provider bills.
- Labeling second billings with “Tracer” or “Second Billing” will cut down on process times.
- A GV modifier is needed if you are billing directly for a physician who is also the patient’s Primary Care Physician. Use a GV modifier and Q5 modifier (reciprocal arrangement) or Q6 modifier (locum tenens physician) if you are billing directly for a physician who is substituting for a patient’s Primary Care Physician.
- A GW modifier is needed on a billing that is denied by us for Non Disease Related
- As of January 1, 2010, CR 6740 states: Part B carriers and/or A/B MACs will no longer recognize AMA CPT consultation codes (ranges 99241-99245 and 99251-99255). For more information please refer to Change Request (CR) 6740 on the CMS website.
Timely Filing Requirements for Medicare Fee-For-Service Claims
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care Act (PPACA), which amended the time period for filing Medicare fee-for-service (FFS) claims as one of many provisions aimed at curbing fraud, waste, and abuse in the Medicare program.
The time period for filing Medicare FFS claims is specified in Sections 1814(a), 1835(a)(1), and 1842(b)(3) of the Social Security Act and in the Code of Federal Regulations (CFR), 42 CFR Section 424.44. Section 6404 of the PPACA amended the timely filing requirements to reduce the maximum time period for submission of all Medicare FFS claims to one calendar year after the date of service.
Under the new law, claims for services furnished on or after January 1, 2010, must be filed within one calendar year after the date of service. In addition, Section 6404 mandates that claims for services furnished before January 1, 2010, must be filed no later than December 31, 2010. The following rules apply to claims with dates of service prior to January 1, 2010. Claims with dates of service before October 1, 2009, must follow the pre-PPACA timely filing rules. Claims with dates of service October 1, 2009, through December 31, 2009, must be submitted by December 31, 2010.
Section 6404 of the PPACA also permits the Secretary to make certain exceptions to the one-year filing deadline. At this time, no exceptions have been established. However, proposals for exceptions will be specified in future proposed rulemaking.
Please be on the alert for more information pertaining to the Patient Protection and Affordable Care Act.
Did you receive a denial letter from us?
- If a billing is Denied - we send you a denial letter with the appropriate reason for the denial marked.
- To receive a packet explaining how to bill when a patient is under hospice care you may call the finance department at 456.0438 and we would be happy to send one to you.
Here are some of our favorite links that may be of use to you.
http://www.cms.hhs.gov/ This is the Center for Medicaid and Medicare Services and has lots of useful information.
http://www.cms.hhs.gov/Manuals/IOM/list.asp The Medicare Claims Processing Manual, CMS Pub 100-4, Ch. 11, sections 40.1.3 and 40.2.
https://wamedweb.acs-inc.com/wa/general/home.do This is the home page of Washington State Medicaid online. WAMedWeb provides the tools and resources to help healthcare providers conduct business electronically with Washington State Medicaid.
This portion of the website is new and we welcome any feedback you have about improvements or additions! Email us at info@hospiceofspokane.org or call 509.456.0438.