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5 Medical Billing Questions You Should Know the Answers

January 6, 2015

Medical_billing_qs Staying well informed on the latest changes in medical billing will ensure your practice runs as effectively as possible with the fewest amount of denied claims. Unfortunately this industry can change quickly, so you really have to make an effort to not just get on top of all the knowledge but also to stay on top of new information. It can become quite difficult to sort through all of the nonsense sent your way, and since some information is more important than others, we have put together this list of the 5 medical billing questions you should know the answers to in order to perform the task successfully.

Question 1: Who can bill claims using the CMS-1500?

Answer: Any non-institutional provider and/or medical supplier may use the CMS-1500 for medical billing purposes. Some examples of providers and suppliers that may qualify include:

  •   Ambulance services
  •   Certified registered nurse anesthetists
  •   Clinic nurse specialists
  •   Clinic psychologists and social workers
  •   Nurse midwives
  •   Nurse practitioners
  •   Physician’s assistants
  •   Providers of clinical diagnostic laboratory services
  •   Providers of home dialysis supplies and equipment

Question 2: What are the benefits when Medicare is not the primary insurance?

Answer: Medicare Secondary Payer (MSP) is the medical billing term used to describe benefits that are available when Medicare is not the primary insurance carrier. Medicare is the primary insurance when the patient is 65 or older and:

  •   Has a small group plan through their own or a spouse’s employer
  •   Has insurance made available through a retirement plan
  •   Medicare is also the primary insurance when an individual is disabled and has a small group plan through their own or their spouse’s employer, regardless of age.

Question 3: Who is the payer of last resort?

Answer: Medicaid is always the payer of last resort when the patient also has coverage under other health plans. Medical providers must notify Medicaid of any third party insurance information they are aware of, in addition to informing them as to any payments they receive on behalf of the recipient.

Question 4: What set of questions are asked to determine MSP situations?

Answer: The Medicare Secondary Payer Questionnaire is given to determine MSP situations. The questions contained in this questionnaire should be asked during each admission for those who have other insurance coverage outside of Medicare. Doing so will also enable providers to determine whether or not other payers are primary or secondary.

Question 5: Which procedure codes are most often used by physicians rendering services?

Answer: CPT codes, which have been developed by the American Medical Association (AMA) in order to identify the most common medical billing codes used by physicians when treating patients. The most frequently used procedure codes are those relating to medical evaluation and management, a few of which include:

  •    99201-05 New Patient Office Visit
  •    99211-15 Established Patient Office Visit
  •    99281-85 Emergency Department Visit
  •    99241-45 Office Consultation

It is essential for everyone who does medical billing on regular basis to know the answers to these five questions. It is very critical for medical billers to have a strong working knowledge of each of these situations. If you were unable to answer all these questions correctly, you may read the whitepaper or feel free to contact us to get more information.


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