caresource fee schedule 2015

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By , July 15, 2015 10:05 pm

caresource fee schedule 2015

http://healthbenefitexchange.ky.gov/Documents/CareSource%20KY%20Gold%20SBC%2010.22.14.pdf
Caresource KY Gold – Kentucky Health Benefit Exchange
Summary of Benefits and Coverage: What this Plan Covers & What it Costs.
Coverage … services? No. You don't have to meet deductibles for specific
services, but see the chart starting on … ADVSBC-KY001(2015)-B-Gold. KY-
EXCM-36-sp.

http://chfs.ky.gov/nr/rdonlyres/bd6a0dd9-0983-4cf9-9bee-06999690e1d6/0/finalsidebysideforregion31_revision391514.pdf
Download – Kentucky: Cabinet for Health and Family Services
Here is information about covered benefits and services and costs for each MCO.
Please read this carefully and … Humana – CareSource™ is the HOME GROWN
choice for quality health care. The well-being of you and … 2015 Benefits Chart.

http://medicaid.ohio.gov/Portals/0/Resources/Managed%20Care%20Reports/MethodsSpecs/2015/L2-2-EncounterDataSch.pdf
ODM Encounter Data Submission Schedule – Ohio Department of …
The Ohio Department of Medicaid's Encounter Data. Submission Schedule:
January 2015. • Mondays – Caresource; Molina. • Tuesdays – United; Buckeye.

http://media.khi.org/news/documents/2014/09/05/analysis-of-2015-premium-changes.pdf
Analysis of 2015 Premium Changes in the Affordable Care Act's …
Sep 5, 2014 … scale to enroll in the second-lowest-cost silver plan and the federal government
covers the difference. … In preparation for open enrollment for coverage in 2015
– which begins November 15 – insurers have …… CareSource.

http://pcaobus.org/about/ops/documents/support%20fee/issuers_paid.pdf
Accounting Support Fee – Issuers Paid – Public Company …
outstanding past-due share of the issuer accounting support fees of the Public …
Standards Board ("FASB"), as of March 20, 2015. 1/ ….. American CareSource.

https://www.cccpp.org/CPP/files/32/32c4682e-0336-4bf1-ba26-897a0e9345b9.pdf
Learn more – Cleveland Clinic Community Physician Partnership
Jan 21, 2015 … the CareSource Advantage HMO SNP plan as of January 1, 2015. …. should be
delivered, rather than being constrained by fee codes …. Oct. 6, 2014,
hydrocodone combination products were rescheduled from Schedule III to.

http://www.cms.gov/Medicare/Medicare-Advantage/MedicareAdvantageApps/Downloads/CY2015_MA_HSD_Network_Criteria_Guidance.pdf
CY2015 MA HSD Provider and Facility Specialties and Network …
Summary of Significant Changes to the CY2015 MA Provider and MA Facility
Criteria . …. MA Provider Table – Select Provider Specialty Types . ….. primary
care source for the beneficiary/member, not supplement a physician primary care
 …

http://www.ncdsinc.com/wp-content/uploads/2015/02/NCDS-Nov-Dec-2014-Update.pdf
Nov – Dec 2014 NCDS Update – NCDS Medical Billing
DAYTON — CareSource, a Dayton-based nonprofit, health plan will team with
Xerox … measures and objectives in 2015, according to a release from CHIME. …
data on quality measures for covered Physician Fee Schedule (PFS) services …

http://www.nga.org/files/live/sites/NGA/files/pdf/2015/1501TheExpandingRoleOfPharmacists.pdf
The Expanding Role of Pharmacists in a Transformed – National …
Jan 13, 2015 … process in 2015. Alternative … forms, and dosage schedules by the CPP; and the
CPP being allowed to … prove care and reduce the costs of treating chronic ….. In
2012, CareSource, a Medicaid managed care plan, began a …

http://www.buckeyehealthplan.com/files/2014/11/MyCare-Ohio-SNF-Training-updated-10-21-14.pdf
SNF Provider Training – Buckeye Health Plan
Nov 1, 2014 … CareSource CareSource … Consumer Hotline to opt-out of Medicare, or
purchased a 2015 Medicare …. fee schedules including bed hold days.

http://www.autismcentralohio.org/sites/default/files/Fall%20ASCO%20newsletter2%202014.pdf
ASCO Fall 2014 Newsletter – Autism Society, Central Ohio
Oct 25, 2014 … manicures provided to you at no cost! Come listen and learn …. from the Nisonger
Center. Click here for The Nisonger 2014-2015 schedule.

https://chapters.theiia.org/dayton/Documents/Dayton%20Chapter%20Newsletter_The%20Wright%20Report_November2014.pdf
Newsletter – Chapters Site – The Institute of Internal Auditors
… Director, McGladrey. CPE: 1 hour relating to Audit. Cost: FREE CPE and FREE
Pizza lunch! RSVP: … CareSource. John. …. hear from you. – John Jenkins,
Dayton IIA President, 2014-2015 Chapter Year … Chart Your Course. Confused
about …

http://www.kidzonemontessori.com/wp-content/uploads/2015/01/Returning-preschool-registration-packet-2015-2016.pdf
2015 Returning Preschool Registration Packet (PDF) – Discovery …
Returning Preschool Registration packet for 2015-2016 … Registration/holding
Fee: Parent/Guardian agrees to pay non refundable registration/holding fee of …

http://www.kentohio.org/tcb/tcbulletin.pdf
TCB Spring 2015 – PAGES – City of Kent
Q Spring 2015 Brush Collection. Q Child ….. usually correspond to the different
tax schedules. … 70% of our costs in our employees we have to make sure we
have enough liquid …… Medicaid, Buckeye, Care Source, and United Tdap, Hep
A.

http://www.butlercountyohio.org/drcourt/PDFs/IVD_form.pdf
odhs 7076 eff. 1/1/2015 butler county csea 315 high street, 7th floor …
Jan 1, 2015 … It also allocates the costs of providing for the health care of the child between ….
CSEA, including appearing at all hearings and appointments scheduled. … ADC/
TANF/OWF or Medicaid/Care Source, I understand that failing to …

http://www.ohiohospitals.org/OHA/media/Images/Finance%20and%20Policy/By-the-Numbers-February-2015.pdf
here – Ohio Hospital Association
Feb 28, 2015 … State Budget Proposals Include Increase in Hospital Franchise Fee … A similarly
timed process will follow each month in 2015 until all … Anthem, Medical Mutual,
CareSource, Molina, Buckeye, Paramount, and United …. OHA's annual meeting
is scheduled for June 8 – 10 at the Hilton Easton in Columbus.

http://www.csa.us/wp-content/uploads/CSACandidateHandbook.pdf
2015 CSA Candidate Handbook – Society of Certified Senior Advisors
2015 Certified Senior Advisors (CSA)® Certification Program. All rights reserved.
…… CSA Office of Certification at 1-800-653-1785 for the fee schedule. All such …

http://www.region10.org/r10website/assets/File/Kaufman%20County%20English%20Resource%202014-2015.pdf
Kaufman County – Region 10 Education Service Center
Child Care Source, The . …… Fee: Sliding scale, Medicaid & private insurance.
CHILDREN'S MEDICAL CLINICS OF EAST TEXAS. (972) 932-1319. Location: …

http://board.coveredca.com/meetings/2014/9-18/PDFs/MASTER%20Reports%20and%20Research%20-%20Table%20of%20Contents_September%2018,%202014.pdf
Reports and Research Table of Contents – Board – Covered California
Sep 18, 2014 … 2015 than they did if they enrolled in the second-lowest cost plan in 2014. There
are … As shown in Table 2, the lowest-cost bronze option across the
marketplaces is increasing by an average of 3.3%, ranging ….. CareSource.

http://www.communitycatalyst.org/initiatives-and-issues/initiatives/voices-for-better-health/dual-agenda-newsletter/the-dual-agenda-february-4-2015/body/01282015-MCOIT-Agenda-and-Reports.pdf
February 2015 – Community Catalyst
January 28, 2015. 1:00 pm – 2:30 pm … 4. DRAFT. MyCare Ohio February 2015
… Caresource. Molina …. The estimated cost of services is the sum of all of these
expenditures. Source: BIAR file and files from … consistent reporting schedule.

medicare gmlos drg

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By , July 15, 2015 5:52 pm

medicare gmlos drg

http://www.hfma-nca.org/documents/2012/PACT%20NCAL%20HFMA%202.2012.pdf
PACT NCAL HFMA 2.2012 – HFMA Northern California Chapter
Feb 14, 2012 … The Centers for Medicare & Medicaid Services (CMS) require patient …. Always
impacts the MS-DRG when LOS is less than GMLOS. Patient …

http://www.ahd.com/studies/TransfersFY08_070828.pdf
Reduced Transfer Adjustments Forecasted Under New MS-DRGs …
Aug 28, 2007 … Changes to the Medicare Inpatient Prospective Payment System … as a hospital's
normal reimbursement for the DRG divided by the GMLOS.

http://hfmanj.org/images/downloads/Presentation/1_hfma_medicare_101__08.13.pdf
Medicare 101 – HFMA NJ Chapter
Aug 22, 2014 … Medicare acute care inpatient, outpatie. • Medicare …. Medicare specified DRGs
…… If LOS is greater than the GMLOS less 1 reimbursement =.

https://cdn.optumcoding.com/upload/pdf/6076/DRG%20Expert%20I-9_2014.pdf
DRG Expert – OptumCoding
DRG Expert. A comprehensive guidebook to the MS-DRG …. 595. Appendix F —
Medicare Case Mix Index Data ………………….. 617 … GMLOS 11.3. AMLOS 13.7.

http://californiahia.org/sites/californiahia.org/files/docs/CDQarticles/2012-10-how-much-revenue-are-you-losing.pdf
How much revenue are you losing due to incorrect patient status …
Split payment methodology used by Medicare to pay claims in which a patient is
… one of the 273 transfer MS-DRGs in which the patient is transferred from an
acute … meeting the geometric mean length-of-stay (GMLOS) for the encounter.

http://vct.iums.ac.ir/uploads/drg_v29.pdf
table 5.—list of medicare severity diagnosis-related groups
Pay. DRG MDC TYPE. MS-DRG Title. Weights. Geo- metric mean. LOS. Arith-
metic mean. LOS. 001. No. No. PRE SURG. HEART TRANSPLANT OR IMPLANT
.

http://www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol2/pdf/CFR-2011-title42-vol2-sec412-4.pdf
Centers for Medicare & Medicaid Services, HHS § 412.4
Oct 28, 2011 … more of the hospital's total Medicare discharges, as … clotting factor provided to
Medicare inpatients … DRG based on the presence or absence.

http://www.trinity-health.org/documents/FY14ProposedIPPSRule.pdf
Hospital Inpatient Prospective Payment System – Trinity Health
(CMS) proposed rule entitled Medicare Program; Hospital Inpatient ….. The FFY
2013 DRG table has 10 DRGs with GMLOS less than 1.5 days, 49 DRGs with.

http://www.norc.org/PDFs/Walsh%20Center/WalshCtr2004_NORCJluy04.pdf
Exploring the Impact of Medicare's Post-Acute Care Transfer – NORC
Jul 1, 2004 … Medicare began to pay acute- care hospital cases in 10 DRGs as transfers
instead of ….. the GMLOS for the DRG, only patients in DRGs with a …

http://www.noviastrategies.com/downloads/case-study-Care-Redesign.pdf
Care Redesign – Noviastrategies.com
processes to achieve quality and financial outcomes. Our Findings. • Medicare
LOS 30% above. Medicare average (GMLOS). • Top 10 Medicare DRGs were.

http://chmbinc.com/wp-content/uploads/2014/05/Performance-Monitoring-for-Hospitalists-CHMB-Ingenous-Med-Nelson-Flores-April-2014.pdf
Performance Monitoring and Dashboards for Hospitalists – CHMB, Inc.
Apr 30, 2014 … Acuity. • CMI. • Top diagnoses or DRGs. – Payor mix. 11 … peer group (e.g.,
Premier, Crimson, etc.) or Medicare. GMLOS. – Severity-adjusted …

http://www.avoidreadmissions.com/wwwroot/userfiles/documents/303/sustaining-your-gains-year-after-year.pdf
LACE Score – Avoid Readmissions through Collaboration
May 6, 2014 … 11,000 Medicare Advantage … o20% of discharged Medicare patients are
readmitted within … o Identify expected GMLOS per DRG o Identify …

http://www.capg.org/ftp/2014CAPGHCC/3_AvoidingReAdmissions.pdf
Preventing Readmissions: – CAPG
May 28, 2014 … Medicare Readmission Reduction Program …. t d GMLOS. DRG o Identify
expected GMLOS per DRG o Identify risk for readmission (LACE …

http://webcast.aats.org/2013/files/Wednesday/20130508_audrm1_1100_12.25%20Wilson%20Y.%20Szeto.pdf
Download Slides – AATS: American Association for Thoracic Surgery …
May 8, 2013 … Medicare pays hospitals by MS-DRG …. GmLOS. 14.1. 9.4. 7.0. 10.4. 6.9. 5.2. Full
Payment. 55,141. 36,781. 30,950. 45,409. 30,376. 25,622.

http://www.floridahfma.org/public.assets/FFY-2015-FINAL-RULE-UPDATE-8-26-14.pdf
Mayo -FFY 2015 IPPS Final Rule Update – HFMA
to impact of MS-DRG documentation and coding effects in FFY 2010, 2011, and.
2012. …. CMS originally intended to use Medicare Cost Report Worksheet S-10
data to develop factor 3. Due to ….. Based on ALOS or GMLOS? • Determining …

http://www.aahs.org/medstaff/wp-content/uploads/InfectDisSpecialists20141.pdf
Infectious Diseases Specialty Intervention Is Associated With …
Sep 25, 2013 … We used administrative fee-for-service Medicare claims to identify beneficiaries
….. DRG-specific GMLOS to exclude less complex cases.

http://www.synapsebiomedical.com/support/PDFs/ALS_Reimbursement/Synapse%202012%20ALS%20Reimbursement%20Guide%2092-0006-2%20Rev%20B%20090512.pdf
NeuRx DPS Reimbursement Support 2012 – Synapse Biomedical
Jan 1, 2012 … Amounts shown are taken from published 2012 Medicare national …… by the
geometric mean length of stay (GMLOS) for that MS-DRG.

http://www.ispor.org/meetings/washingtondc0512/releasedpresentations/W14-All-Slides.pdf
Real World Evidence: Feasibility and Advantages of Linking … – ispor
Jun 5, 2012 … Type of insurance (Commercial, self-insured, Medicaid, Medicare, etc) …. Medical
treatments and drug prescriptions. ‒ ….. CMS Avg GMLOS.

http://www.poma.org/Portals/0/Conventions/Dist8/Pedano.pdf
Coding and Documentation Integrity – Poma.org
Jan 29, 2015 … coding opportunities to maximize Medicare payment that is …. DRG: 204 RW 0.67
Mortality 2.0 Complication: 6% GMLOS 3.4. READM: 7.71.

http://www.researchgate.net/profile/Edwin_Huff/publication/13140640_Developing_quality_of_acute_care_indicators_through_claims_data_augmentation/links/09e41500026cc3eb1e000000.pdf
Developing Quality of Acute Care Indicators Through Claims Data …
acute care hospitals and physician stafl's serving Medicare beneficiaries in
Vermont and New Hampshire, with more than 60,000 Medicare inpatient
admissions ….. Group (DRG) database published … GMLOS = geometric mean
length of stay.

coding for contracted physicians?

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By , July 15, 2015 3:55 pm

coding for contracted physicians?

http://www.bcbstx.com/provider/pdf/obstetrical_billing_multiple_birth_guidelines.pdf
Obstetrical Billing & Multiple Birth Guidelines – Blue Cross and Blue …
Jan 27, 2010 … Services included in the Global OB CPT®' Code 59400 (Vaginal delivery) …
Physicians will be reimbursed for the initial OB visit separately … The primary
procedure will be allowed at 100% of the contracted rate, subject to the.

https://www.locumtenens.com/media/44159/billingforlt.pdf
How to Bill for Locum Tenens Services – LocumTenens.com
A recent survey by physician staffing firm LocumTenens.com revealed that 16
percent of respondents who hire locum tenens physicians do not bill for their
services. Based on the amount … if this were a new physician. (Some coding
sites claim … physician's NPI. If you are not contracted, credentialing is usually
not required.

http://www.tdi.texas.gov/forms/finmcqa/FIN536.pdf
HMO Provider Contract Checklist – Texas Department of Insurance
HMO-PHYSICIAN/PROVIDER CONTRACT CHECKLIST. Although … this
document, you are advised to consult the Texas Insurance Code, Title 28 of the
Texas …

http://www.tuftshealthplan.com/providers/pdf/payment_policies/nonreimbursable_code_list_physicians.pdf
Nonreimbursable Code List for Physicians – Tufts Health Plan
1 This list applies to physicians and NPs/PAs who are contracted as PCPs …
Some procedure codes are either reimbursed as part of a more comprehensive …

http://www.jpands.org/vol17no2/huntoon.pdf
CPT Coding – Journal of the American Physicians and Surgeons
Financing Administration (HCFA) to impose use of the CPT coding system on all
… by private bounty hunters contracted by CMS to recoup money paid to …

https://www.aaoms.org/docs/practice_mgmt/beneficiaries_chart.pdf
May privately contract with Medicare patients, billing the provider's …
these instances. The –GJ modifier. (opt out physician or practitioner emergency
or urgent service) must be appended to the procedure code on the claim form.

http://www.bcbst.com/providers/manuals/bcbstPAM.pdf
COMMERCIAL Provider Administration Manual – BlueCross …
Jun 1, 1997 … Retrospective Review. 2. Licensed Physicians Requiring Minimal Supervision …
HealthCare Common Procedural Coding System (HCPCS) d.

https://www.bcbsfl.com/DocumentLibrary/Members/MajorMedicalClaimForm.pdf
InstructIons for fIlIng a MedIcal claIM — Please read … – Florida Blue
Use a separate claim form for each family member and each physician or
supplier. 3. … q Type of service and procedure code … Please be aware that if the
provider or supplier is contracted with Blue Cross and Blue Shield of Florida,
payment.

http://www.jacksoncoker.com/Documents/LT-billing.pdf
Billing for Locum Tenens Physicians – Jackson & Coker
When billing for a locum tenens physician replacing a current employed
physician who is unavailable … physician. 6. Claims must contain the modifier Q6
after the procedure code in box 24D … Non-Contracted Payers—Commercial
Insurance.

http://www.tuftshealthplan.com/providers/pdf/payment_policies/physician_assistants.pdf
Physician Assistant Professional Payment Policy – Tufts Health Plan
Plan, and to those physician assistants who elect not to sign a contract with Tufts
… codes. As these revisions are made public, Tufts Health Plan will update its …

https://www.acponline.org/running_practice/payment_coding/medicare/chronic_care_management_toolkit.pdf
Chronic Care Management Tool Kit – American College of Physicians
What Practices Need to Do to Implement and Bill CCM Codes … a contracted
third party and whose CCM services are generally supervised by the clinician, …

http://www.pyapc.com/resources/collateral/white-papers/Chronic-Care-Whitepaper-PYA.pdf
Providing and Billing Medicare for Chronic Care Management – PYA
The following analysis assumes a family medicine physician with an average …
physician (or other qualified practitioner), CCM offers providers a bridge over the
….. Thus, a provider could contract with a third party to provide non-face-to-face …
the reported data towards the monthly minimum time for billing the CCM code,.

https://www.pmphmo.com/documents/providers/marketplace_provider_directory.pdf
Contracted Providers Directory – Preferred Medical Plan
Primary Care Physicians. 1. FAMILY PRACTICE. ZIP CODE: 33010. Orlando
Moreno MD. 2801 W 12 Avenue. Hialeah, FL 33010. (305) 661-6336. Hrs: M,W 9
-7; …

https://www.iehp.org/Secure_Site/LogIn/PDF/ACA_FAQ.pdf
ACA Medi-Cal Primary Care Physician Rate Increase
calendar year can use billed Medi-Cal codes for the prior month. 3. … Non-
contracted and out-of-area Physicians are still eligible for the enhanced payment
as …

http://www.ashp.org/DocLibrary/Policy/Ambulatory-Care/Pharmacist-Billing-in-Physician-Based-Clinic-FAQ.pdf
Pharmacist Billing in Physician Based Clinics – ASHP
Therapy Management (MTM) CPT codes or another preferred mechanism. 2, 3, 4
… contracted to the physician or Medicare Part B-approved provider.

http://www.cigna.com/assets/docs/health-care-professionals/853221_NETWORK_NEWS_2Q12.pdf
Network News For Health Care Professionals Parti… – Cigna
to include new Current Procedural Terminology (CPT) codes released by the ……
direct patient referrals to other participating, contracted physicians and facilities …

http://www.reinhartlaw.com/publications/documents/ea060309hc.pdf
Hospice Physician Billing for Medically Necessary – Reinhart …
As the role of medical directors and hospice physicians increases, and direct
care … or contracted physician, the coding for any physician visits billed by
hospice …

http://www.centercare.com/pdf/referenceGuides_nat_803774_2013_2ndqtr.pdf
Cigna Reference Guide for physicians, hospitals … – Center Care
For physicians, hospitals, ancillaries, and ….. Credentialing for Physicians and
Health Care Professionals . ….. Standard Claim Coding/Bundling Methodology.

http://www.valueoptions.com/providers/Files/pdfs/Suboxone_FAQ.pdf
Outpatient Detoxification (Detox) Buprenorphine … – ValueOptions
ValueOptions® contracted physicians may update their participation … Please
verify what diagnosis codes4 are included in the Outpatient Detox/Buprenorphine
.

http://highered.mheducation.com/sites/dl/free/0073402036/639219/Chapter01.pdf
Chapter 1 Chapter 2 Chapter 3 – McGraw Hill Higher Education
Patients who come to physicians' practices for medical care are obligated to pay
for the services they … diagnosis code ethics etiquette …. zation agrees to the
contract and then offers the coverage to its group members. People who are not …

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