What's the difference between Home Health and Home Care? How do Medicare Part A and Part B work? How do you order DME for your patient? When and how should you order home oxygen? What's new in the eldercare space?
For physicians, other healthcare professionals, and senior-serving professionals, interacting with Medicare can be complicated and wrought with pitfalls, which, if not understood and managed, will mire your practice in endless paperwork and frustration.
We interview industry experts in every aspect of healthcare, from insurance companies, DME companies, home health agencies, medical providers, and many others, to bring you their real world expertise in the American healthcare system.
Your hosts are Dr. Amy Schiffman and Dr. Alex Mohseni, two Emergency Medicine physicians who have branched off from traditional Emergency Medicine to explore and build solutions with a particular focus on eldercare and population health.
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What's the difference between Home Health and Home Care? How do Medicare Part A and Part B work? How do you order DME for your patient? When and how should you order home oxygen? What's new in the eldercare space?
For physicians, other healthcare professionals, and senior-serving professionals, interacting with Medicare can be complicated and wrought with pitfalls, which, if not understood and managed, will mire your practice in endless paperwork and frustration.
We interview industry experts in every aspect of healthcare, from insurance companies, DME companies, home health agencies, medical providers, and many others, to bring you their real world expertise in the American healthcare system.
Your hosts are Dr. Amy Schiffman and Dr. Alex Mohseni, two Emergency Medicine physicians who have branched off from traditional Emergency Medicine to explore and build solutions with a particular focus on eldercare and population health.
Join our Facebook group: https://www.facebook.com/groups/602747270479020/
Join our Subscriber List and get exclusive access to our Mastering Medicare Cheat Sheet and other goodies: https://www.masteringmedicare.net/subscribe
Episode 21: CPT Codes and How You Get Paid in Medicare
Mastering Medicare
42 minutes 43 seconds
2 years ago
Episode 21: CPT Codes and How You Get Paid in Medicare
Discussion topic: Getting paid through the Medicare system
Introduction to CPT codes and HICPICS codes
Medicare's payment process for healthcare providers
Future guests and topics related to Medicare reimbursement
Mention of the Aging Here newsletter and interview opportunities
Differentiating between CPT codes and ICD-10 codes
History and purpose of CPT codes
Explanation of RVUs (Relative Value Units) and how doctors are paid
Simplified process of submitting CPT codes to Medicare for payment
Potential fraud issues in fee-for-service Medicare
Importance of documentation and medical necessity for CPT codes
Challenges with lack of comprehensive guidelines for new codes
Providers struggle with the interpretation and utilization of CPT codes.
Some codes are rarely utilized, while others require expertise to maximize billing.
Coding rules can be complex, with restrictions on code combinations and frequency of billing.
Providers face the risk of financial penalties or legal consequences for incorrect coding.
Medicare is a significant payer and requires compliance with its rules.
Physicians, nurse practitioners, and physician assistants primarily use CPT codes.
Modifiers can be used to bill for additional services or special circumstances.
Hospice CPT codes exist separately from Part B coding.
CPT codes have RVUs (Relative Value Units) that determine payment.
RVUs are divided into work RVUs, which assess the labor involved in a procedure.
Work RVUs consider time, technical skill, physical effort, mental effort, judgment, and stress.
Work RVUs are subject to negotiation and lobbying each year.
The conversion factor translates RVUs into payment amounts.
The conversion factor is subject to annual adjustments and can significantly impact reimbursement.
Mastering Medicare
What's the difference between Home Health and Home Care? How do Medicare Part A and Part B work? How do you order DME for your patient? When and how should you order home oxygen? What's new in the eldercare space?
For physicians, other healthcare professionals, and senior-serving professionals, interacting with Medicare can be complicated and wrought with pitfalls, which, if not understood and managed, will mire your practice in endless paperwork and frustration.
We interview industry experts in every aspect of healthcare, from insurance companies, DME companies, home health agencies, medical providers, and many others, to bring you their real world expertise in the American healthcare system.
Your hosts are Dr. Amy Schiffman and Dr. Alex Mohseni, two Emergency Medicine physicians who have branched off from traditional Emergency Medicine to explore and build solutions with a particular focus on eldercare and population health.
Join our Facebook group: https://www.facebook.com/groups/602747270479020/
Join our Subscriber List and get exclusive access to our Mastering Medicare Cheat Sheet and other goodies: https://www.masteringmedicare.net/subscribe
