Monday, May 24, 2010

EDI and PC - ACE PRO 32 - billing software

ELECTRONIC DATA INTERCHANGE (EDI)

The Administrative Simplification Compliance Act (ASCA) requires that providers submit claims to Medicare electronically to be considered for payment, with a limited number of exceptions. If a provider meets one of the exceptions, the provider is waived for a period of two years.
Exceptions to this requirement, include:

•Small providers, defined as a physician, practitioner, or supplier with less than 10 full time equivalent employees
• Roster billers of Medicare covered mass immunizations
• Claims for payment under Medicare demonstration projects when information is required that cannot be submitted electronically
• Claims where Medicare is the tertiary payer to two (or more) primary payers , and
• Dental claims.

More EDI information is available on the WPS Medicare Website at http://www.wpsmedicare.com/part_b/business/edi_hipaa.shtml.

PC-ACE PRO 32 ELECTRONIC BILLING SOFTWARE

PC-Ace Pro32 is a free, stand-alone software package that creates a patient database and allows your office to electronically submit most WPS Medicare Part B claims electronically. PC-Ace has many built in features to lighten your office's workload. The software provides you with the ability to enter patient information, claim information, procedure file information, and creates a summary report of the claims you submit electronically.
If you are interested in using PC-Ace Pro-32 in your office, visit the WPS Website at http://www.wpsic.com/edi/pcacepro32.shtml or call our Electronic Data Interchange (EDI) department at (866) 503-9670.

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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download