May 8, 2016
Billing for Services A physician or other supplier may bill and receive Part B payment for the technical component (TC) or professional component (PC) of diagnostic tests which the physician or other supplier contracts a physician, medical group, or other supplier to...
May 5, 2016
A/B MAC (B) Payment Rules If a diagnostic test (other than a clinical diagnostic laboratory test) is personally performed or is supervised by a physician, such physician may bill under the normal physician fee schedule rules. This includes situations in which the test...
Apr 25, 2016
Claims submitted for the global or technical component of certain ultrasound procedures when billed in combination with other ultrasound procedures for a single member within the same visit will be denied as they are considered to be included within another procedure....
Apr 20, 2016
Providers are compensated according to Tufts Health Plan network contracted rates regardless of the address where the service is rendered. Claims are subject to payment edits that are updated at regular intervals and generally based on Centers for Medicare &...
Apr 15, 2016
As a condition of fee schedule payment, services are required to contribute directly to the diagnosis or treatment of an individual beneficiary.5 When Medicare Administrative Contractors (MAC) receive a single claim for interpretation and report, “they must...
Sep 7, 2015
Summary of Policies in the Calendar Year (CY) 2015 Medicare Physician Fee Schedule (MPFS) Sustainable Growth Rate (SGR) The Protecting Access to Medicare Act of 2014 provides for a zero percent update from the CY 2014 rates for services furnished between...
May 1, 2011
When Anti-Markup Does Not Apply The anti-markup payment limitation will not apply if the performing physician “shares a practice” with the ordering/billing physician or other supplier. There are two alternatives for determining whether a performing/supervising...
