Learn Medical Billing Process, Tips to best AR Specialist. Medical Insurance Billing codes, Denial, procedure code and ICD 10, coverage guidelines. Demographic, charge, payment entry, AR process and eligibility and follow up. How to Guide.
Pages
- Home
- Medical Billing Question and Answer - Terms
- Insurance Denial Claim Appeal Guidelines.
- Medical Billing Downloads
- Understand Medical Billing
- Medical Billing Outsource
- Medicare Coverage and Plan Overview
- Advertise with us
- EVALUATION AND MANAGEMENT CPT code [99201-99499] - Full List
- Overall Medical billing process
- CPT Code 99201, 99202, 99203, 99204, 99205 - Which code to USE
- Internal Medical Billing Audit - how to do

SERVICES PROVIDED BY NON-PHYSICIANS AND RESIDENT PHYSICIANS Payment policy
A. All non-physicians, who are defined as eligible providers under the member’s BCBSKS contract and who are providing services as defined in their Kansas licensure or certification, shall bill their charges to BCBSKS under their own National Provider Identifier (NPI) or specific performing provider number, if applicable. The name of the ordering provider, when applicable, (including NPI, except when exempt by law) must appear on every claim.
B. A physician may bill for the services of a licensed nurse, other than an APRN, if there is an employer/employee relationship and the services are supervised by the physician (supervision means the patient recognizes the supervising physician as his/her physician and there is a periodic review of the records by the physician). These services must be an integral part of the physician's professional service, included in the physician's bill, and be of the type that are commonly furnished in the physician's office or clinic.
C. Independently practicing Advanced Practice Registered Nurses (APRNs) who are providing services as defined in their Kansas licensure or certification, shall bill their charges to BCBSKS under their own NPI or specific performing provider number.
The name of the ordering provider, when applicable, (including NPI, except when exempt by law) must appear on every claim.
D. Services of a Resident Physician are billed under the attending Faculty Physician’s NPI or specific performing provider number if done in connection with the Residency Program.
E. If the Resident Physician is providing services outside of the Residency Program, all Blue Shield Policy Memos apply and services shall be billed under his/her own NPI or specific performing provider number.
F. BCBSKS will not pay for any services performed and billed by an independent provider who does not meet applicable state or national license registration or certification requirements to perform that service or who is not defined as an eligible provider in the member’s contract.
G. BCBSKS will not pay for outpatient services connected with a nervous and mental diagnosis when provided by an unlicensed provider, or a licensed provider with a license other than designated in the member’s contract as eligible to provide nervous and mental benefits. Supervision of an unlicensed provider, a licensed counselor, or one not designated as eligible in the member’s contract does not constitute a service being rendered by an eligible provider. The exception to this would be if the service was rendered through a state licensed alcohol or drug abuse treatment facility, a hospital, psychiatric hospital, or a community mental health center. Eligible non-physician psychiatric providers include APRNs, certified psychologists, licensed specialist clinical social workers, licensed clinical marriage and family therapists, licensed clinical professional counselors, and licensed clinical psychotherapists.
Labels:
Medical billing basics
Subscribe to:
Post Comments (Atom)
Medical Billing Popular Articles
-
Medicare denial code and Descripiton 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent ...
-
CPT CODE AND Description 99391 - Periodic comprehensive preventive medicine reevaluation and management of an individual including an age...
-
Its often confused that BCBS have lot of prefixes and where to contact. However we have some guide to follow, using prefixes we could find t...
-
CPT code and description 80050 - General health panel This panel must include the following: Comprehensive metabolic panel (80053), ...
-
Procedure CODES and Descriptions 99401 - Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an indi...
-
CPT Code and description 99381 - Initial comprehensive preventive medicine evaluation and management of an individual including an age an...
-
procedure code and description 90832 Individual psychotherapy, insight oriented, behavior modifying and/or supportive, 30 minutes with t...
-
Billed amount: It is the Amount charged for each service performed by the provider. In other words it is the total charge value of the cla...
-
Medicare Part B - Colorado P.O. Box 650705 Dallas, TX 75265-0705 Claims - Medicare Part B - Indian Health P.O. Box 660159 Dallas, TX 75266-...
-
Lucrative career opportunities for medical billing specialists When you think of large hospital networks, the first picture that comes to ...

No comments:
Post a Comment