* Missed appointments by the member must be followed-up by the provider.
The CarePlus Member Services Department will assist the Provider in this process if necessary. If the patient does not go to the previously scheduled appointment without prior cancellation, Provider must document within the medical records. A Provider may charge a fee for missed appointments, provided such fees apply uniformly and at the same amount for all Medicare and non-Medicare patients.
APPOINTMENT SCHEDULING CRITERIA:
To ensure accessibility and availability of health services to plan members, the following standards have been set forth by the Centers for Medicare & Medicaid Services (CMS):
* Urgently needed services or Emergency – immediately.
* Non-urgent, but in need of attention – within one (1) week.
* Routine and Preventive Care – within 30 days. Non-emergent complaints that do not restrict a member’s activity or are chronic in nature.
* Provider agrees to maintain hours that do not discriminate against Members’ accessibility to Provider.
In addition, CarePlus recommends the following standards for all physicians:
* Response to urgent calls within 15 minutes; response to routine calls within 24 hours.
* After hours, response to urgent calls within 15 minutes; nonurgent response in 30 minutes.
* The average wait time should not exceed 60 minutes from the scheduled appointment time. This includes time spent both in the waiting and examination room prior to being seen by the physician. In the case of an unexpected emergency, which may cause this standard to be exceeded, the member should be promptly notified and given the option of waiting or rescheduling.
By monitoring compliance with these guidelines over time, CarePlus can take action to improve member service availability and access to medical services when necessary. CarePlus may monitor compliance with the above-mentioned access standards through a variety of ways including site visits, telephone audits, member surveys and complaints.
Medicare Guideline posts
- Finding Medicare fee schedule - HOw to Guide
- LCD and procedure to diagnosis lookup - How to Gui...
- Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline,
- Step by step Guide Medicare participation program
- Medicare Fee for Office Visit CPT Codes - CPT Code 99213, 99214, 99203
- Medicare revalidation FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Top Medicare billing tips
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee...
This post has Most used J code list and we are constantly updating with example . If you are looking particular J code, use search button. ...
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr...
Flow Cytometry is a highly complex process by which blood, body fluids, bone marrow and tissue can be examined. It provides important immun...
Procedure code and description 93015 (cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous ele...
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 36416 Collection of capi...
Coverage Indications, Limitations, and/or Medical Necessity This LCD describes conditions under which the coverage of nail avulsion/ex...
procedure code and description 93922 LIMITED BILATERAL NONINVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, (EG, FOR LOW...
Procedure code and description 95004 Percut Tests w/ Extrac Immed React # Allergy testing - Percut allergy skin tests - Percutaneous ...
Molecular diagnostic testing, which includes DNA- or RNA-based analysis, with or without amplification/quantification, provides sensitive, ...