Medicare Guideline posts
- Home
- 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 process - how often provide need to do - FAQ
- Gastroenterology, Colonoscopy, Endoscopy Medicare CPT Code Fee
- Medicare claim address, phone numbers, payor id - revised list
Skilled Nursing Facilities - Revenue code 0551, 0552
Revenue Codes
• Skilled Nursing
o 0551 – visit charge
o 0552 - hourly
• Indicate “21X”, “22X” or “23X” in type of bill field, which is field 4 for paper claims.
o First digit – Type of facility (2)
o Second digit – Bill classification (inpatient - 1, inpatient Medicare B only - 2 or outpatient - 3)
o Third digit – Frequency (e.g., admit thru discharge claim, etc.)
• Hospital Swing Bed claims should be billed with the “18X” type of bill and the taxonomy code for the hospital’s swing bed unit.
• For Florida Blue and BlueOptions members, provide the authorization/certification number on the claim. Plan of treatment should not be submitted with claim, unless requested.
• Submit room and board units to reflect the length of stay minus one unit for the discharge day. Day of discharge or death is not considered a covered day, unless admitted and discharged/deceased on the same day. For example, if a claim is submitted for dates of service 8/1/2014 to 8/7/2014, then the room and board units should be 6 to exclude the day of discharge or death.
• Refer to contractual reimbursement terms to determine if billing is based on Skilled Nursing Facility (SNF) revenue codes or HIPPS RUG codes. Typically only Medicare Advantage provider contracts are negotiated based on the inpatient prospective payment system for SNFs.
• Florida Blue requires SNF claims are submitted with the 191-194 or 199 revenue codes that represent sub-acute care. Any inpatient SNF claims for Non-BlueMedicare members that do not contain these specific room and board codes will be returned to the provider for appropriate billing.
Subscribe to:
Post Comments (Atom)
Top Medicare billing tips
-
Procedure code 77427: Radiation treatment management, 5 treatments Procedure code 98966: Telephone assessment and management service provi...
-
CPT 99201 Office or other outpatient visit for the evaluation and management of a new patient, which requires these three key components: a...
-
CPT 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of...
-
Procedure code and description 93000 - Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report -average fee... -
CPT CODES and Description 81000 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitr... -
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. ...
-
Procedure Codes and Definitions 36415 Collection of venous blood by venipuncture - Fee schedule amount $3.10 - Private insurance pay upt... -
Procedure code and description 93224 - External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage;...
-
Procedure code and description 11400- Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion d...
-
CPT CODE and Description 90785 - Interactive complexity (List separately in addition to the code for primary procedure) 90791 - Psychi...
No comments:
Post a Comment