When a patient moves from fee-for-service Medicare into a Medicare Advantage plan, the payer changes, the coverage rulebook changes, prior authorization appears, and the appeal ladder starts at the plan. Here is what changes and what the practice can still do about a denial.
The difference between modifier Q6 and modifier Q5 is whether money passes between the two physicians. Here is what CMS requires for each arrangement, the 60-day limit that applies to both, and the record an auditor asks for.
A desk reference for choosing the level of an evaluation and management service: the two code families, medical decision making against total time, the three elements, and the settings that do not follow the office rules.
The wellness visit is a prevention plan, not a physical. Here are the codes, the clocks, the health risk assessment requirements, and the documentation test that decides whether a problem visit on the same day pays.
One calendar year from the date of service, no grace period, and four exceptions that each need documentation before a contractor will look at the claim. Here is what the clock actually measures, what the appeals process expects, and the internal deadlines that keep claims from aging into a write-off.
Medicare revalidation is the recertification every enrolled practice has to run on a five year clock, and the due date is public. Here is how to look it up, when to file, and what a missed deadline actually does to your claims.
