Healthcare Financial Services
Physician supervision of any patients under home health (or hospice) is called Care Plan Oversight (CPO). These patients receive complex healthcare that requires a physician to be involved on an ongoing basis. CPO is not covered for patients in a skilled nursing facility (SNF) or other nursing facilities, only hospice and home health.
Telemedicine visits are doctor visits for either new or established patients, only they take place on some type of live virtual platform instead of in person. The healthcare industry is beginning to more readily accept this type of doctor visit, but the billing requirements can be confusing, and reimbursement varies.
The medical history of a patient is one of three principal components required in determining the level of the encounter and the status of the patient (new or established).
The definitions of new or established patients relate to services from a physician or qualified healthcare professional licensed from the same specialty and subspecialty in the same group practice.
Inpatient billing can be confusing.
The first aspect to understand is that it is not based on the status of the patient. New or established status does not apply to inpatient billing codes, as they are used for an initial doctor visit, whether the practitioner has an established relationship with the patient.
Beginning July 1, 2015, Medicaid is no longer reimbursing partial Medicare Part B coinsurance amounts. The total Medicare/Medicaid payment to the provider will not exceed the amount that the provider would have received for a Medicaid-only patient. If the Medicare payment is greater than the Medicaid fee, no additional payment will be made
Medicare is health insurance for people 65 or older, certain people under 65 with disabilities, and people of any age with End-Stage Renal Disease.
Complications of pregnancy – health problems that are caused by pregnancy. Below is a list of most commonly coded maternity complication.
J7324 – Orthovisc – 30 mg injection: 1 billing unit = 30 mg
Maximum 8 injections per 180 days
4 units every 180 days per knee
30 mg once weekly x 4 doses
NDC Number 59676-0360-01
A fetal non-stress test (NST) 59025 is a noninvasive test performed on pregnant women in order to monitor the fetal heart rate. A nurse will listen to and record the baby’s heartbeat while the baby is resting and while the baby is moving. Not all pregnant women require an NST. It usually takes 20 to 40 minutes to complete an NST.