Reimbursement 101 2011 - Cardinal Health

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Reimbursement - Clinic Setting and Physicians Medicare Part B: • Payments are made under the Medicare Physician Fee SSchedule h d l (MPFS); (MPFS) payment t rates t updated d t d annually ll • Each CPT procedure code is assigned a payment level and can be billed in the following g ways: y • Technical component only (covers equipment, supplies, office expense, non-physician staff) • Professional component only (covers physician interpretation of scan) • Global – Technical plus professional component combined • Part B contractors have multiple p fee schedules within their 18 geographic jurisdiction (payment amounts vary based on geographic index) © Copyright 2011, Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Reimbursement – RP in Clinic Setting 19 Medicare Part B: • Radiopharmaceuticals p ppaid separately p y – Based on invoice, i.e., no ceiling per se or – Up to a maximum allowable the contractor has set; typically 95% AWP – Providers should bill what they paid for the dose and Medicare will reimburse up to the maximum allowable • Note: some (not ( all) ) contractors ppost a RP fee schedule on their website © Copyright 2011, Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Page 1 and 2: Nuclear Medicine Reimbursement 101
Page 5 and 6: Reimbursement Terminology 5 • HCP
Page 7 and 8: Reimbursement Terminology 7 • HOP
Page 9 and 10: NM Reimbursement 101 > A/B MACs 9
Page 11 and 12: A/B Medicare Administrative Contrac
Page 13 and 14: NM Reimbursement 101 > A/B MACs 13
Page 15 and 16: NM Reimbursement 101 15 © Copyrigh
Page 17: Reimbursement - Hospital Outpatient
Page 21 and 22: Reimbursement - Private Payers 21
Page 23 and 24: Coverage • Most important issue i
Page 25 and 26: Coverage - Private Payers • Incre
Page 27 and 28: Coverage - Medicare A service or pr
Page 29 and 30: Coverage - Medicare 29 • In gener
Page 31 and 32: CMS Coverage with Evidence Developm
Page 33 and 34: PET Coverage > Medicare Medicare Na
Page 37 and 38: Coding 37 • ICD-9-CM - Internal C
Page 39 and 40: Coding 39 CPT/HCPCS codes • The n
Page 41 and 42: Coding Modifiers • Two character
Page 43 and 44: Coding - Hospital Revenue Codes •
Page 45 and 46: Coding > Claim Forms • Hospitals
Page 47 and 48: Coding > Claim Form 1450 (Hospital)
Page 53 and 54: Coding > Claim Form 1500 Clinic/Phy
Page 55 and 56: NM Reimbursement 101 - References 5
Page 57 and 58: NM Reimbursement 101 - References h

Reimbursement 101 2011 - Cardinal Health

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