Tuesday, August 31, 2010

what are the important field to check before claim submission

Verify all data pertaining to the service is correct. Correct data allows the service to process as is intended, eliminating the need to make corrections after the claim has processed.
  • NPI of Billing Physician
  • Assignment or Non-assignment of claim
  • Health Insurance Number (HIC) of the beneficiary
  • Zip Code of the place of service
  • All related diagnosis reported with the highest degree of specificity
  • NPI of Referring Physician
  • Date of service
  • Place of service
  • Procedure code
  • Modifiers when applicable
  • Number of service(s)
  • Billed amount for each service
  • NPI of Rendering Physician
  • Clinical Laboratory Improvement Amendment Number (CLIA) for laboratory services
  • The date last seen/X-ray date, initial treatment date for Podiatry, Physical Therapy and Chiropractic services
  • Primary payer data
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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