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The California Department of Health Care Services (DHCS) is a department within the California Health and Human Services Agency that finances and administers a number of individual health care service delivery programs, including Medi-Cal, which provides health care services to low-income people.
The National Uniform Billing Committee (NUBC) is the governing body for forms and codes use in medical claims billing in the United States for institutional providers like hospitals, nursing homes, hospice, home health agencies, and other providers. The NUBC was formed by the American Hospital Association (AHA) in 1975. [3]
Berenson-Eggers Type of Service (BETOS) categories are used to analyze Medicare costs. All Health Care Financing Administration Common Procedure Coding System ( HCPCS ) procedure codes are assigned to a BETOS category.
Medical billing, a payment process in the United States healthcare system, is the process of reviewing a patient's medical records and using information about their diagnoses and procedures to determine which services are billable and to whom they are billed.
Such coding is necessary for Medicare, Medicaid, and other health insurance programs to ensure that insurance claims are processed in an orderly and consistent manner. Initially, use of the codes was voluntary, but with the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) use of the HCPCS for ...
The California Medical Assistance Program (Medi-Cal or MediCal) is the California implementation of the federal Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level.
These reforms are set to take place before the Patient Protection and Affordable Care Act takes effect in 2014. [13] Healthy Way L.A. provides a primary care provider team to members and expanded access to primary, preventative and specialty services, as well as access to hospital-based inpatient and outpatient services. [ 14 ]
Mutually Exclusive Code Pairs (MEC): these code pairs should not be reported together because they are mutually exclusive of each other. NCCI code pairs must match on member, provider, and date of service. CMS maintains tables of code pair edits and updates these tables on a quarterly basis.