A Reimbursement limeline ( continued)

A Reimbursement limeline ( continued)

1960s: Medicare, Medicaid, CHAMPUS, CPT developed by AMA 1970: Self-funded employer plans; OSHA 1972: PSROs for utilization, quality, and medical necessity 1973: HMOs 1974-2010: Numerous acts legislated 2010-2021: ACA, HITECH, value-based care, meaningful use/ promoting interoperability, FY 2022 Hospice Wage Index and Payment Rate, 21st Century Cures Act, FDARA Act of 2017

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http://www.nlm.nih.gov/medlineplus/ency/article/001933.htm
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Inpatients and outpatients use the CMS-1500, or UB04.

CMS stands for the Centers fo Medicare and Medicaid Services. UB stands for uniform billing, established by the National Uniform Billing Committee.

Information about both of these claims can be found at CMS.gov

http://www.cms.gov/site-search/search-results.html?q=cms-1450 billing
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– Have staff dedicated for document review – including checks for accuracy and completion – cleanup, and follow-up on care to prevent any additional delays.

http://www.healthcareitnews.com/news/claims-scrubbers
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