Explanation:
Children under the age of 21 who are registered in Medicaid can receive comprehensive and preventative health care services through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program. In order to guarantee that kids and teenagers receive the proper preventative, dental, mental health, developmental, and specialist care, EPSDT is essential.
Explanation:
All insurance providers must be assessed the same usual and customary amount (U&C). To ensure full reimbursement, the U&C sum should always be set higher than the highest-paying insurance provider.
Explanation:
Each CPT code has a pricing structure for the reimbursement of professional fee visits. ICD-10 CM diagnosis codes are not reimbursable in a professional context, however, inpatient facility reimbursement is based on Diagnosis Related Groups (DRGs), which are groups of related diagnoses. Although they are employed in an inpatient context, ICD-10 PCS procedure codes are not reimbursed.
Explanation:
HIPAA is allowed 30 days under the Privacy Rule, and an extra 30 days may be added if you notify the patient in writing.
Explanation:
Medicaid patients cannot be billed without their written consent. The chiropractor needs to give her her money back and correctly charge her insurance. The remaining sum cannot be charged to the patient later, even if a service is not covered when invoiced to Medicaid.
Explanation:
Medicare claims must be filed within 365 days or one year. Other insurances, including Humana, have 90-day timely filing deadlines. After a year, claims can still be submitted to Medicare, but they will be rejected for not being timely filed, and no payment will be made.
Explanation:
Copays are a flat fee, whereas coinsurance is a percentage of the contractual allotment. The contractual discount is the usual and customary amount (U&C) less reimbursement and less patient obligation. The contractual allowance is the sum for which the provider was directly reimbursed plus the patient's duty.
