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Editor's Choice Consolidated Nursing Home Billing The 1997 Balanced Budget Act required Medicare to pay for services provided to patients in a Medicare covered Skilled Nursing Facility with a single payment for most services, rather than individually.  The nursing home must bill Medicare for this payment, and may not bill separately for certain services, such as PT/OT, the technical component of x-rays and many drugs.   Medicare allowed certain services provided by a physician to be billed and paid separately from the consolidat ... Read More The Ins and Outs of Medical Credentialing Credentialing refers to the process used by hospitals and health plans for approving physicians. Each entity grants approval after reviewing and verifying a physician’s credentials. What may seem like a simple process actually involves tedious paperwork and unnecessary bureaucracy.   Why is the credentialing process so complicated? Because every state, hospital, and insurance company maintains different rules, forms, processes and requirements. You need to learn the special nuances ... Read More Incident to Services for Medicare Patients Incident to services is a Medicare provision which allows physician offices to bill for services provided by a Non-Physician Practitioner or nurse or medical assistant under the physician's provider number.  The service is then paid at 100% of the Medicare Fee Schedule. NPPs may bill services under their own provider numbers, but in that case, the services are reimbursed at 85% of the Medicare Fee Schedule.  The NPP must be operating within their state scope of practice. Incident to r ... Read More The mission of Codapedia™ is to build a community of volunteers (Codapedists) to create the world’s best and most comprehensive resource for coding and reimbursement for physician services.  Codapedia™ will be 100% free, with costs underwritten by advertising.