Medical Billing Blog

Stay up to date with the latest revenue cycle news, trends, and policies.

Home Health Billing Requirements: An Overview of Medicare’s Eligibility Standards

By: Gilbert Johnston

November 1, 2019

home health billing requirements

To Qualify for Home Health Care Under Medicare, Three Requirements must be Met:

The patient must be:

1) confined to his/her home

2) in need of skilled services, AND

3) be under the care of a physician & recommended for home health care by a physician

This article explains, in detail, what actions Medicare considers sufficient to meet each of these three requirements. This is a useful guide for both patients and clinicians looking to develop a firm understanding of the insurance coverage requirements for home health billing.

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Surgery Billing – A Guide to Medicare’s Global Surgery Package

By: Robbin Grayson

August 20, 2019

surgery billing and the global package

When it comes to medical billing for surgery, there are various claim submission requirements within Medicare. The largest and most broadly applied is called The Global Surgery Package, or more simply, Global Surgery.

Global surgery refers to all the necessary services performed by a surgeon before, during, and after a surgical procedure. It also includes any necessary services performed by members of that surgeon’s team (provided they practice within the same specialty).

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Telemedicine Guide: Medicare Coverage and The Medical Billing Process

By: Gilbert Johnston

June 27, 2019

Telehealth doctor providing services

Every year, telemedicine grows in popularity. More than half of U.S. hospitals already have some sort of telemedicine program, and countless more hospitals are currently developing programs. By 2022, analysts believe that the telemedicine industry will be worth as much as $70 billion.

To accommodate this growing healthcare trend, commercial health insurers are increasingly adopting new telemedicine coverage plans, as well as expanding existing plans. For physicians looking to grow their practices, now is the time to jump into Telehealth, as coverage has expanded to the point where it makes fiscal sense. In fact, most mid-range insurance plans now cover telemedicine to some extent.

However, before jumping into this new form of care, it’s important to understand how the reimbursement process works. As with most new forms of medical treatment, The Centers for Medicare and Medicaid Services (CMS) has set the initial coverage standards through Medicare. The commercial carriers have followed suit, with similar coverage rules.

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MIPS 2019 – Summary of the Biggest Changes to the 2019 Final Rule (vs. 2018)

By: Cal LaGroue

March 1, 2019

medical billing prices

MIPS 2019 is here. It may seem too soon, as some clinicians are still finishing their reporting for the MIPS 2018 performance year. However, the time has come. The Quality performance category requires clinicians to report a full year’s worth of data. So, the sooner providers start, the better.

To help you get going quickly, we’ve summarized the biggest changes to the MIPS 2019 Final Rule, as compared to 2018.

As this is the third year of MIPS, the requirements have increased, along with the potential penalties. The CMS is raising the stakes, so to speak. However, clinicians can still avoid negative payment adjustments without too heavy a burden. While the demands have technically doubled for 2019, providers still only need to score 30 out of 100 possible points to escape penalty. That’s certainly doable.

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