Billing Regulations
Accountable Care Organizations (ACO) - ANS is an organization working to better coordinate patient care
The National Correct Coding Initiative (NCCI, or more commonly, CCI) - ANS an automated edit system to control specific Current Procedural Terminology (CPT) code pairs...
Billing Regulations
Accountable Care Organizations (ACO) - ANS is an organization working to better coordinate
patient care
The National Correct Coding Initiative (NCCI, or more commonly, CCI) - ANS an automated
edit system to control specific Current Procedural Terminology (CPT) code pairs that can be
reported on the same day.
Local Coverage Determination (LCD) - ANS decision made by a Medicare Administrative
Contractor (MAC) on whether a service or item necessary or reasonable, and therefore covered
by Medicare within the specific region that the MAC oversees
National Coverage Determination (NCD) - ANS A national coverage determination (NCD) is a
United States nationwide determination of whether Medicare will pay for an item or service.
Incident-to billing - ANS is a way of billing outpatient services (rendered in a physician's office
located in a separate office or in an institution, or in a patient's home)
Incident-to billing - ANS provided by a non-physician practitioner (NPP) such as a nurse
practitioner (NP), physician assistant (PA), or other non-physician provider. Incident-to billing
can be confusing (cms.gov)
Improper coding also might occur through "unbundling" or "fragmentation. - ANS Unbundling
or fragmenting billing codes illegally increases a provider's profits by billing bundled procedures
separately, which results in higher reimbursement from Medicare and Medicaid.
With EHR software - ANS providers can copy and paste notes from a patient's previous visit
into each current treatment note, which can make it appear that the provider has diagnosed and
treated every condition on that list.
(EOBs) - ANS Explanation of Benefits
Appeals - ANS A medical appeal for a payment is a reconsideration for payment after the
patient has been billed by the physician or medical facility
Appeals - ANS The appeal maybe granted by the, medical insurance, third party, physician or
medical facility or it can be denied.
Clearinghouses - ANS where claims are sent for payment, the clearing house is a financial
institution formed to facilitate the exchange of payments, securities, or derivatives transactions.
Crosswalking - ANS is the mapping of codes between the equivalent or near equivalent
between different code sets
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