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Section III. Revenue Cycle Management

• General Information
  
  • PBHS FY 2022 Health Home
    
  • PBHS FY 2022 MH Individual and OMHC
    
  • PBHS FY 2022 PRP and Specialty Programs
    
  • PBHS FY 2022 PRP Cascade
    
  • PBHS FY 2022 - 1915
    
  • SUD FY 2022 MD Medicaid Fee Schedule​
    
  • OPTUM Updated Fee Schedules
    
  • HIT Payer Coverage Billing Expansion COVID-19​
    
  • CMS Checking Medicare Eligibility
  • No Surprise Act CMS-10780
  • 1500 Health Insurance Claim Form Reference Instruction Manual
  • 1500 Claim Form Instruction Manual 2021 07 V9
  • SUD FY2021 Fee Schedule Effective 01012021 Rev. 04012021
  • SUD FY2022 Medicaid Fee Schedule
  • Maryland Medicaid Dental 2021 CDT Fee Schedule (FY21)
  • Revenue Cycle Management
  • Revenue Cycle Management Process
  • Glossary of Health Coverage and Medical Terms
  • Office of Inspector General Waiving of Co-Pays and Co-Insurance
  • Advanced Practice Health Care Provider Policy, Professional Reimbursement Policy​​​​​​​​​​
  • Telehealth Center for Connected Health Policy - Telehealth 2021 Billing Guide
  • 2021 MD Medicaid Medical Laboratory Fee Schedule 2.16.21
    
  • 2021 Medicaid Professional Services Fee Schedule 1.1.21 Updated 3.10.21
    
  • CMS MLN How to Use NCCI Medicaid​
    
  • Family Planning Revenue Cycle Assessment Tool​
  • CARDEA Revenue Cycle Management Process
    
  • 21 CDT Fee Schedule Updated 1.7.21​
• Front-End Processes
  • FY2022 Ability to Pay Outpatient​​
    
  • Revenue Cycle Management - Front End Processes
    
  • Front Office Training Checklist
    
  • ​​Patient Registration Form
    
  • FY 2020 Non-Chargeable Services
  • ​FY 2020 Ability to Pay Schedule
    
  • Medicare Eligibilty Verification FACs 9.2020​
    
• Coding and Documentation
  
  • ICD 10 PCS Official Guidelines for Coding and Reporting 2023​
  • COVID-19 New Administration Code for Pfizer Pediatric Vaccine Booster Dose
    
  • ​FAQs Evaluation and Management Services  (Part B)
    
  • AMA CPT Coding Alert Covid Booster Updates  May 2022​​
  • Mid-Level Provider Billing Grid 4 2022​
    
  • AMA Announces CPT Update for Pediatrics​
  • ​CMS MM12581 New Waived Test​​
    
  • AMA 2022 CPT Changes Summary
  • CMS COVID-19 New HCPT Codes for Remdesivir MLN Jan. 7 2022​​
    
  • CMS MLN006818 2021 12 Clinical Laboratory Fee Schedule 508
  • CMS 2022 Updated Therapy Codes; MM12446
  • CMS Clinical Laboratory Fee Schedule CY 2022 Final Payment Determinations
  • JHHC New CPT Codes Requiring Prior Authorization
  • JHHC Updated Reimbursement Guidance for CPT 99072
  • OPTUM ICD-10 Diagnosis List Revisions 11.24.21
  • Telehealth Payer Billing Guide Revised 12.01.2021
  • Revenue Cycle Management - Clinical
    
  • Medicare 99211 Checklist
  • CMS Evaluation and Management Services Guide
  • Novartis Psychiatry Audit Guide
  • COVID-19 Reimbursable Laboratory Codes Fee Schedule Update
    
  • COVID-19 Reimbursable Vaccine and Infusion Codes Fee Schedule
  • 2021 MD Medical Assistance Professional Services Provider Manual Website
  • Sample Explanation of Benefits - 508
  • History of Present Illness and Review of Systems Guidelines
    
  • MLN New Modification of POS Codes for Telehealth​
  • CMS COVID-19 Vaccines and Monoclonal Antibodies​​​​​​​​​​​​​​​
    
  • AMA Announces CPT Updates for Pediatrics
  • CMS MM12581 New Waived Test​
    
  • CMS Flu Shot Coding 2021
  • AMA New Codes for COVID Immunizations
  • 2022 ICD-10-CM Updates Guides​
    
  • UHC Advanced Practice Health Care Provider Policy Professional - Reimbursement Policy - Commercial Plans​​
    
  • CMS MLN Healthcare code Sets ICD 10
    
  • OPTUM Changes to CARC Codes
  • UHC Digital Solutions Comparison Guide
  • UHC Provider Claim Review Tool
  • ​UHC Advanced Practice Health Care Provider Policy Professional - Reimbursement Policy​​​​​​
    
  • CMS Addition of QW Modifier
  • AMA News Alert CPT Codes for Novavax Vaccine for COVID-19​​
    
  • ​COVID-19 Vaccine Billing and Coding
    
  • ​AMA Technical Corrections 2021 EM Updates
    
  • AMA Updates March 2021 CPT Office Prolonged SVS Code Changes
  • COVID-19 Coding Guidelines 2021
  • Value Initiative ICD 10 Code Social Determinants of Health
  • ​​AMA CPT Revised MDM Grid
    
  • CMS Scoring EM Office Output Services​​
  • Telehealth Payer Billing Guide Revised 2021​
  • MGMA EM MDM Tool 2021
    
  • CPT MPFS Update Worksheet 2021​
    
  • ​Medicare Novitas E and M Slide Deck 9.23.2020​​
    
  • Review of Systems​
    
• Billing Office Processes
  • ​Revenue Cycle Management
    
  • Claims
    • Medicare CMS Billing Form​
      
    • CMS 1500 Claim Form - How to Avoid Common Denials
      
    • 1500 Health Insurance Claim Form Reference Instruction Manual
    • Maryland Medicaid Professional Services Provider Manual
      
    • 10 Common Medical Billing Mistakes that Cause Claim Denials
    • Medicare Provider Enrollment
    • Medicare Processing Manual
    • Medicare Processing Manual - Preventive and Screening Services
    • Medicare Processing Manual Completing and Processing Form CMS-1500
    • Reimbursement for Lab Tests Performed in the Clinic
    • Payor Provider Portals
    • Billing Credentialing Physician Extenders (Nurse Practitioners and Physician Assistants)​​​​​​​​​​​
    • Claim Adjudication & Remittance Advice Guide​
      
    • Payor Billing Guide for NP and PA Providers​
      
  • Payments
    
    • Electronic Remit Advice (ERA) and Standard Paper Remit (SPR)
    • Priority Partners EOB Notice​
      
    • How to Read an Explanation of Benefits (EOB)​
      
    • Sample Medicare EOB​
    • Sample EOB - Two Payors
    • Sample EOB​
  • Collections
    
  • CCU COMAR Regulations
  • State/Local Agency Instructions: Using CCU's Access Database Template
  • CCU Electronic Excel Referral File Template
  • Sample Financial Hardship Policy​​​​
  • CCU COMAR 2017
  • CCU Debit Form
    
  • Federal Register - Discount Co-Pay Third Party
    
  • Reports and Administration
    
  • ​Revenue Cycle Management - Key Performance Indicators (KPIs)
  • Key Performance Indicators for Peak Financial Performance
  • Sample Medical Practice Internal Control Work Program
  • ​Outsourcing Billiing Considerations
    
  • ​Outsourcing Billing Considerations​​
    
    

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