Reimbursement 101 2011 - Cardinal Health

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Nuclear Medicine Reimbursement 101 2 The Three Major Components of Reimbursement • Coverage • Coding • Payment Coverage + Correct Coding = Payment/Reimbursement $$ © Copyright 2011, Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
Nuclear Medicine Reimbursement 101 3 But First…Before we explore details of coverage, coding, and actual payments: We need some foundational information • Reimbursement Terminology • Overview of Medicare Administrative Contractor (MACs) System • Payment y Systems y © Copyright 2011, Cardinal Health, Inc. or one of its subsidiaries. All rights reserved.
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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 and 18: Reimbursement - Hospital Outpatient
Page 19 and 20: Reimbursement - RP in Clinic Settin
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 35 and 36: Nuclear Medicine Reimbursement 101
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
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NM Reimbursement 101 - References 5
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NM Reimbursement 101 - References h
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Nuclear Medicine Reimbursement 101
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Reimbursement 101 2011 - Cardinal Health

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