With the novel coronavirus continuing to circulate and cause severe illness in the United States and worldwide, getting a flu vaccine is more important than ever. The 2020–21 influenza season will coincide with the continued circulation of coronavirus, so start planning now. Common signs and symptoms of COVID-19 (e.g., fever, cough, and dyspnea) can also […]
With schools and colleges back in session, you can only hope patients start coming in for their influenza vaccine, so communities can keep the spread of seasonal flu to a minimum this year. Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug […]
The Center’s for Medicare & Medicaid Services (CMS) just released the updated 2019 ASP drug pricing files for July. These files contain the payment amounts to be used to pay for Part B covered drugs in the third quarter. Updated July 2019 payment limits are also available; effective July 1, 2019, through September 30, 2019.
Comparing the new third quarter 2019 payment amounts with the prior quarter reveals that payment amounts for the top 50 Part B drugs increased by an average of 0.6 %. Local Medicare contractors will determine any Medicare Part B payment limits for valid HCPCS codes not included in the quarterly ASP pricing files.
The payment allowance limits subject to the ASP new codes include the following
ASP Drug Pricing Files Update Released for July 2019 The Centers for Medicare & Medicaid Services (CMS) just released the updated 2019 ASP drug pricing files for July, available at CMS.gov. These files contain the payment amounts to be used to pay for Part B covered drugs in the third quarter. Updated July 2019 payment limits […]
Hey there I was approached by a company to do a consulting job on a workman’s comp case to review billing and coding to see if fee’s were usual and customary for a plaintiff’s case, this is from an attorney. I have never done this type of consulting before and do not know how to price it out as they are asking for a rate. I do have 19 years in the medical billing and coding industry through. They are asking for the following:
Chart Review: $ AMOUNT/hour Deposition: $ AMOUNT/hour Court: $ AMOUNT/day With an hourly retainer requested.
I had come up with the following amounts and think that this is reasonable:
Chart Review: $ 25/hour Deposition: $ 150/hour Court: $ 600/day With an hourly retainer requested $ 50.
Am I being too low or to high in some of the area’s. Any help would be of great use. Thanks as this isn’t something you can easily research. I figure the chart review’s can be done at home so no traveling, but with traveling being done for any depositions or court dates I did increase the price. Any helps would be great thanks.
So, my company recently took on an Urgent care office which I now do the billing for. The way they have the system set up (which was adapted from the previous owners), we bill out a different amount for each plan that requires code S9083 in place of E/M codes. As far as I have always known, regardless of what the plan allows, for consistency we are supposed to bill out the same amount to all insurances. I have searched the web and exhausted all other resources trying to find out if this rule applies to my urgent care global code. Please help!!!
I’m looking for software that will, as accurately as possible, estimate Medicare pricing for outpatient hospital and ASC claims when coding has been added; something similar to the CMS PC pricer for inpatient claims. Maybe an APC grouper. Does anyone have any resources where I can find information?
Recently there has been a lot of discussion in the self-funded world about Reference-Based Pricing (RBP) and the vendors offering this solution to help these plans save money. The model used in this context advertises an "open network" (go to any provider) then provides the employer with a medicare-based (or cost-based) cap on the payment for services and legal defense for employees who are balance billed. I’ve seen a few law suits pop up this year regarding this model (Utah and California) and there is ample online documentation on the payor side on how to implement (with language templates), but there doesn’t appear to be much in the public domain (on the provider side) identifying a clear process on how this sort of plan is handled in the revenue cycle. Is anybody aware of posted statement, template letter responses, seminars from conferences, or powerpoints put together by contracting/collection vendors for providers that explains how to address self-funded Reference-Based Pricing plans. I am asking because I would like to write an article about how reference-based pricing has increased in self-funding, and how providers have responded. For the moment, the general vendor sales documents online say that most providers accept these rates and very few providers balance bill the patients. I’ve even read the slogan "The best way to pay less for healthcare, is to pay less for healthcare." The few lawsuits I have found seem to indicate some systems do not accept this payor model, but outside of a letter or two I have yet to find any primary sources identifying a comprehensive approach or hospital system posted statements that this type of insurance is not accepted. I’d really appreciate some facility posted statements or collection vendor template documents that would allow the article to present the entire present picture for this RBP movement in the self-funded world.
