The Novitasphere website is a free and secure portal that allows users to access, view, and electronically print funds transfer through a secure website portal provided by Novitas Solutions. The site allows providers, settlement services, and clearinghouses to receive electronic funds transfers for free.
Full Answer
What is Novitas health insurance?
With more than one contract with the Centers for Medicare & Medicaid Services (CMS), Novitas Solutions, Inc. (Novitas) offers innovative management services for government-sponsored health programs. It is private health insurance specifically designed to supplement Medicare benefits by filling some of the gaps in Medicare coverage.
What is the novitasphere website?
The Novitasphere website is a free and secure portal that allows users to access, view, and electronically print funds transfer through a secure website portal provided by Novitas Solutions. The site allows providers, settlement services, and clearinghouses to receive electronic funds transfers for free.
How are the professional services of a PA billed?
The professional services of a PA can be billed only by the PAs employer. The services of other practitioners (including clinical social workers and occupational therapists) are bundled when furnished to hospital and CMHC patients. These nonphysician practitioner services are billed as partial hospitalization services.
Do NPS get Medicare billing privileges?
Obtained Medicare billing privileges as a NP for the first time before January 1, 2001. Incident to services and supplies may be covered. Payment is made directly to the NP for assistant-at-surgery services at 85% of 16% of the amount a physician is paid under the Medicare PFS for assistant-at-surgery services.
What is a referral for BHI?
The BHI services require that there must be a presenting psychiatric or behavioral health condition that, in the clinical judgment of the treating physician or other qualified health professional, warrants “referral” to the behavioral health care manager for further assessment and treatment through provision of psychiatric CoCM services or General
What is a behavioral health care manager?
As noted in the CY 2017 PFS final rule, (81 FR 80231), the behavioral health care manager is a designated member of the care team with formal education or specialized training in behavioral health (which would include a range of disciplines, for example, social work, nursing, and psychology), but Medicare did not specify a minimum education requirement. They may or may not be a professional who meets all the requirements to independently furnish and report services to Medicare. The behavioral health care manager must be available to provide services face-to-face with the beneficiary, have a continuous relationship with the beneficiary, and have a collaborative, integrated relationship with the rest of the care team. He or she must also be able to engage the beneficiary outside of regular clinic hours as needed.
What is a BHI code?
The BHI codes allow for remote provision of certain services by the psychiatric consultant and other members of the care team. For CoCM, the behavioral health care manager must be available to provide face-to-face services in person, but provision of face-to-face services is not required. The BHI codes do not describe services that are subject to the rules for Medicare telehealth services in the narrow meaning of the term (under section 1834(m) of the Social Security Act).
Do you need prior consent for BHI?
Prior beneficiary consent is required for all of the BHI codes, recognizing that any applicable rules continue to apply regarding privacy. The consent will include permission to consult with relevant specialists, including a psychiatric consultant, and inform the beneficiary that cost sharing will apply to in-person and non-face-to-face services provided. Consent may be verbal (written consent is not required) but must be documented in the medical record.
Do you need a visit for BHI?
No, the only required visit is the initiating visit, which is only required for new patients or patients not seen within a year of commencement of BHI services , and could be furnished the preceding calendar month. For CoCM, the behavioral health care manager must be available to provide his or her services face-to-face service with the beneficiary as needed, but there is no other requirement for in-person care.
Can BHI be used in both facility and non-facility settings?
Yes, the BHI codes are priced in both facility and non-facility settings. The POS on the claim should be the location where the billing practitioner would ordinarily provide face-to-face care to the beneficiary.
Can BHI codes be used for substance use disorders?
No, as provided in the CY 2017 PFS Final Rule (81 FR 80232), the BHI codes may be used to treat patients with any mental, behavioral health or psychiatric condition that is being treated by the billing practitioner, including substance use disorders. We did not limit billing and payment for the BHI codes to a specified set of behavioral health conditions. The services require that there must be a presenting mental, psychiatric or behavioral health condition(s) that, in the clinical judgment of the billing practitioner, warrants BHI services. The diagnosis or diagnoses could be either pre-existing or made by the billing practitioner and may be refined over time.
What is non diagnostic outpatient?
Nondiagnostic outpatient services related to a beneficiary’s hospital admission and provided by the admitting hospital, 3-days (or 1-day) prior to inpatient hospital admission, including the date of admission, are considered inpatient services and must be included on the inpatient hospital claim.
What is condition code 51?
If the nondiagnostic outpatient services are not related to the inpatient admission, the hospital must report condition code 51 (attestation of unrelated outpatient non-diagnostic services) on the outpatient claim. Hospitals must maintain documentation in the medical record to support that outpatient nondiagnostic services are unrelated to ...