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Showing posts with the label Billing Rules

Golden Rule - Pulse Oximetry with Evaluation & Management

CPT Code Description: - 94760 - Noninvasive ear or pulse oximetry for oxygen saturation; single determination 94761 - Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (e.g., during exercise) The provider and or other qualified healthcare professional takes the oxygen  saturation using the a sensor on the ear or finger from the patients. To perform this service, the doctor places a sensor, such as one in the form of a clip, on the patient’s earlobe or fingertip. The sensor uses a light shining through the body part to measure the oxygen saturation, detecting the differences in the ways blood cells with and without oxygen reflect light.   The Oxygen saturation, is also called as O2 sat, and the percentage of hemoglobin carrying oxygen molecules.   Guidelines: - The CPT Codes ranges from 94010 to 94799 include laboratory procedure(s) and interpretation of test results. If a separate identifiable evaluation and management service is performed on the same day

CMS Unveils Surprise-Billing Rules

Proposed Billing Rules 2022 CMS unveiled July 2 the first in a series of rules aimed at shielding patients from surprise billing. The interim final rule addresses several provisions in the No Surprises Act passed by Congress last year. Most provisions outlined in the proposed rule will not take effect until Jan. 1, 2022.  Ten things to know, 1. Bans surprise billing for emergency services The interim final rule bans surprise billing for emergency services, regardless of where they are provided.  Providers are required to bill emergency services on an in-network basis without prior authorization. 2. Bans high out-of-network cost-sharing for emergency and non-emergency services  CMS proposed that patient cost-sharing, including coinsurance and deductibles, be based on in-network provider rates.  This means that cost-sharing can't be higher than if the services were provided by an in-network physician.  3. Bans surprise billing for ancillary services and any "others."  The i