The below articles are all published in BC advantage
Magazine and written and contributed by Steve
Verno
Steve Verno Medical Billing and Coding Instructor/Consultant
at Quality Medical Management/Emergency Medicine Specialists
Miami, Florida
Medicare Advantage Part 2
Correct Coding Initiative The "correct coding initiative" (CCI) is the name of the payment edits used by Medicare for physician, lab, and some other services. In addition, some of the CCI edits are incorporated into Medicare's "outpatient code editor...
Read
Medicare Advantage - Part 1
Medicare Advantage is also known as Medicare Part C. IT used to be called Medicare + Choice. Medicare Advantage is Medicare that is provided by private health insurance companies. Medicare Advantage could be an HMO, PPO, POS or a Fee For Service Pla...
Read
Provider-Billing Agent Contracts
I receive many e-mails and read postings by medical billers that say, I was terminated by my provider and he wants his information returned to him. What should I do, how long do I continue to work on the claims I sent and how am I to be paid for the ...
Read
Medicare and Physicals
Recently, I have been receiving e-mails and I have been seeing questions asked on the many Medical Coding and Billing Forums regarding Medicare patients and routine physicals. The question most asked is, "Does Medicare pay for physicals and if so, wh...
Read
Terminating the Patient-Provider Relationship
In March of this year, I suffered a heart attack and underwent a quadruple bypass surgery and consequently am now under the care of a cardiologist. To make a long story short, my experience with the doctor's office has been poor. I have had appointme...
Read
Prevention of Silent PPOs
Silent PPOs are called by some as being illegal and some are calling their tactics shady. Steve Verno discusses how to prevent dealing with someone you don't know.
...
Read
Medicare as a Secondary Payor and the Working Aged
Why are we in a hurry to send a claim when we could take a few minutes to do what we should be doing to ensure we send a claim to the correct payor? Steve Verno writes for us regarding Medicare as a Secondary Payor issues.
...
Read
Appeal's - New variables to consider (Plus FREE sample letter)
Appealing today, is no longer the same as it used to be. At one time you could create a generic appeal letter but the insurance companies have seen these tons of times and have come up with ways to deny these appeals. In addition, there are new varia...
Read
STOP: Common Billing Errors
The following list includes common billing errors that you should avoid when submitting your claims to Medicare carriers:
...
Read
Opting Out of Medicare
Opting out of Medicare is an option but do we know the choices and responsibilities we have to help our providers with this decision? Steve Verno writes about opting out of Medicare and what you need to know to avoid potential problems.
...
Read
Health Insurance Contracting and the Patient
Developing the insurance contract with an insurance company is as simple as A-B-C, right? The patients always pay their copays, coinsurances and deductibles, right? Wrong! So what can be done to help us with these crucial reimbursements? Steve Verno ...
Read
Medical Billing Resolutions
We are now deep into the Christmas Season and it is time for many practices and billing companies to close down for a short period so that the staff can take a few days off for holiday vacations. This is an excellent time to sit down and write out yo...
Read
A Reason Why Patients Don't Pay Their Bills
I'm sitting at home, going over my bills and I have a medical bill for me, my wife and my son. The claims were sent to my insurance and applied to my deductible. I called the number on the bill, so that I can give them my credit card number and be ...
Read
The Feelings of Disappointment
Steve Verno, CMBS writes: I've been in the medical field since 1971. I started out working at a local hospital taking care of patients. I remained in the medical field for the next 21 years. I can't count how many patients I treated over the years. W...
Read
Getting into the 21st Century
Being a provider and medical biller today, is a world of cell phones, faxes, internet, laptops, pocket PCs, e-mails, instant messaging, debit cards, employer sponsored health care, electronic claims, insurance verification, direct deposits, and remit...
Read
ERISA vs State Law
At issue is a State's Assignment of Benefit law that requires the insurance company to honor the AOB and send payment to the provider. Our favorite insurance company, BCBS was not honoring the AOB and was sending payment to the member. Their reason w...
Read
Deductibles?
What is a deductible? A deductible is a contractual requirement to have the patient or member pay a specified amount before the insurance company will pay any benefits that are due to the member. The amount of a deductible is based on how much a pe...
Read
Timely Filing Denials
Every day, I see people asking questions about how their claim was denied due to timely filing reasons and the person asking wants to know if there is a modifier, or another CPT code that can be used to overturn the denial. From a personal perspectiv...
Read