Links and Tools

This is the reference page for all the links and tools we have given you. If you save any page to your favorites, this would be the smart one to choose. As of 09/29/16 I have updated this page to link to the article that each spreadsheet or link refers to. The articles have detailed explanations and this change will make navigating the blog considerably more convenient.

Medicare Links:

Medicare Immunizations: http://www.cms.gov/Medicare/Prevention/Immunizations/index.html

Please reference Medicare and Immunizations

Medicare Fee Schedule Look Up: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup/index.html

Please reference Please post your payments

High Risk Indicators for Medicare: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/cancer_screening.pdf

Please reference Everything you ever wanted to know about pap smears

Other Links:

Place of service listing: http://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.htmlhttp://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html

Please reference Place of service listing

Insurance Commissioner: http://www.insurance.ca.gov/

Please reference The insurance denied your claim, now what?

Billing Tools:

Updated modifier chart

Please reference Modifer 25 and 59

Pap rules

Please reference Everything you ever wanted to know about pap smears

Copay Log

Please reference Cash in the Office

Timely Filing Guide

Please reference Timely filing limits

Global period for procedures

Please reference Modifiers 24 and 79

Place of service list

Please reference Place of service listing

Appeals Tools:

Sample Appeal Letter

Please reference The insurance denied your claim, now what?

Medical necessity template appeal letter

Please reference  The insurance denied your claim, now what?

Example of a letter requesting retro authorization

Please reference Every practice does it…

Example of a letter requesting retro authorization for a MR Risk HMO

Please reference How to bill Medicare HMOs

Downloadable non-contracted patient guide

Please reference Every practice does it…

Psych Tools:

insurance verification form

Please reference Psych Secrets

List of county mental health carve outs

Please reference Medi-Cal and Psychiatry (Tip: It’s a Mess)

Flow chart for Medi-Cal psych claims

Please reference Medi-Cal and Psychiatry (Tip: It’s a Mess)

Workers Comp Tools:

Doctor’s First Report

PR-2 Report

OMFS Schedule – For claims older than 2014. California uses the Medicare fee schedule as of 01/01/14.

OMFS DME Prices

NDC Numbers for substances

OMFS Fee schedule for pharmeceuticals

EAMS

Front Desk Tools:

Front desk checklist

Please reference The front lines in the battle for your A/R

Practice Managing Tools:

2014 PQRS Individual Measure Spec Manual

Please reference Medicare PQRS reporting

2015 PQRS Individual Measure Spec Manual

Please reference Medicare PQRS reporting

2015 PQRS Implementation Guide

 Please reference Medicare PQRS reporting

W9 Form

cms855i

cms855b

2 responses to “Links and Tools

  1. Stephanie Wells

    Modifier 25 issue – Patient see’s PCP and is only charged for E/M. On the same day the patient also see’s Cardiologist and has an unscheduled procedure. I am working on the Facility only charges. The E/M for the PCP visit does not get a modifier 25. The Cardiologist visit E/M gets the modifier 25 due to the separate procedure. All the charges are on the same UB. Am I correct in stating that a modifier 25 only goes on one (the cardiology) of the visits and not both E/M charges. Also, this would be for a Medicare claim.

    • Would this be covered under Medicare part A or Medicare part B? If you are billing on the CMS-1500 forms with CPT and ICD9 codes, then I can probably help, but if you are billing on UB04 forms, I have never learned how to bill on those. And what type of facility is it?

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