Modifier 80 is used in medical billing to indicate that an assistant surgeon was required during a surgical procedure. When a patient undergoes a surgery that requires the assistance of a second surgeon, Modifier 80 is added to the primary surgeon’s CPT code to notify payers (such as Medicare, Medicaid, or private insurance) that the … Read more
Introduction Modifier CS is a code used to indicate that a service or procedure was related to COVID-19 testing or treatment. It was introduced by the Centers for Medicare and Medicaid Services (CMS) as part of the response to the COVID-19 pandemic. This modifier ensures that certain healthcare services associated with the testing and treatment … Read more
Introduction When billing for services, selecting the correct Place of Service (POS) code is critical to ensure clean claims and proper reimbursement. One frequently used—but sometimes misunderstood—POS code is 20, which represents an Urgent Care Facility. Let’s break down what POS 20 is, when it should be used, and how it affects billing and reimbursement. … Read more
Definition Place of Service Code 11 is used on professional claims (CMS-1500 form) to indicate that the service was provided in a physician’s office, or a clinician-owned or leased space used to treat patients on an outpatient basis. CMS definition: “Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, … Read more
In medical billing, the term subscriber refers to the primary individual who holds a health insurance policy. The subscriber is responsible for maintaining the insurance plan and ensuring that premiums are paid. The subscriber can also extend coverage to dependents, such as spouses or children, depending on the policy’s terms. Roles and Responsibilities of a … Read more
Eligibility Criteria: To be eligible for Medicaid, an individual must be a U.S. citizen or a permanent legal resident for at least five continuous years and also meet at least one of the following Medicaid eligibility criteria: Federal Poverty Level Guidelines: Claim Submission:
1. Age-Based Eligibility 2. Work History or Spousal Coverage 3. Early Enrollment Options 4. Medicare Parts & Enrollment Essentials Part Overview Eligibility / Timing Part A Hospital Insurance Free with 40 credits; otherwise paid Part B Medical (Doctors, Outpatient) Enrollment typically at 65; late penalties if delayed Part C Medicare Advantage (via private insurers) Must … Read more
Payment calculation without sequestration, Billed Amount = $40.00 Allowed amount = $20.00 Paid amount = $16.00 Patient responsibility (Coinsurance) = $4.00 Payment calculation with sequestration, The sequestration … Read more
