Saturday, October 2, 2010

SUBMITTING documents electronically

Electronic Claims Attachments

Claim attachments are supplemental documents providing additional medical information to the claims processor that cannot be accommodated within the claim format. Common attachments are Certificates of Medical Necessity (CMNs), discharge summaries and operative reports. They are sent to the carrier/intermediary with the original claim or in response to a request from a carrier/intermediary.

On September 23, 2005 a Notice of Proposed Rule Making (NPRM) was published in the Federal Register announcing proposed standards for six types of electronic claims attachments and the standard to be used by health benefit plans to request an attachment and identify the type of information that is needed. A copy of the implementation guide proposed in that NPRM as the national standard for these attachments is available without cost at the Washington Publishing company web site. A link is provided below.

There is a link to the NPRM available through a separate CMS web page. Instructions and the deadline for submission of NPRM comments and actions to be taken by CMS once that comment closes is included on that page. A link to that webpage is also provided below.

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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