HCC Blog by Caridad

you can find guidance about coverage and billing for preventive and screening serves in Chapter 18 of the Medicare Claims Processing Manual Chapter 18 - Preventive and Screening Services https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c18.pdf Major Category IV: Excluded Preventive and Screening Services Preventive and screening services are excluded from the Part A payment made under the SNF PPS, but are subject to SNF CB. As such, they are separately payable under Medicare Part B, but only to the SNF. The SNF must bill the services listed on the next page for beneficiaries in a Part A stay with Part B eligibility on TOB 22X. ===== The first two files list codes that physicians, nonphysician practitioners, and suppliers (other than ambulance suppliers) can bill separately to the Part B MAC . If neither file lists the code for the service, the service is subject to SNF consolidated billing and the physician, nonphysician practitioner, or s...

The Office of Inspector General (OIG) report “The Hospital of Central Connecticut Incorrectly Billed Medicare Inpatient Claims With Kwashiorkor” dated June 2015.    The OIG was looking to determine if the Hospital was complying with Medicare billing requirements for Kwashiorkor.   Kwashiorkor is a type of severe protein malnutrition. It generally is found in children living in parts of the world without and adequate food supply or due to a famine. Since Medicare is primarily covering people 65 years or older, it is doubtful this condition would be prominent. The following link leads to the finds of their investigation.   http://oig.hhs.gov/oas/reports/region9/91402036.pdf

This is a great website that offers the opportunity to learn many different subjects.  It is one of my favorites and it's free! http://www.gcflearnfree.org/ #HCC #ICD10 #CMS #ICD9 #RiskAdjustment #ICD10questions   #Career #MedicalCoding #Coding       Disclaimer : This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.   The information presented herein is for general informational purposes only and is accurate as of the date of