web01.fireside.fm Sat, 04 Apr 2026 22:28:01 -0500 Fireside (https://fireside.fm) Mastering Medicare - Episodes Tagged with “Medicare Provider Requirements” https://www.masteringmedicare.net/tags/medicare%20provider%20requirements Tue, 06 Jun 2023 13:00:00 -0400 What's the difference between Home Health and Home Care? How do Medicare Part A and Part B work? How do you order DME for your patient? When and how should you order home oxygen? What's new in the eldercare space? For physicians, other healthcare professionals, and senior-serving professionals, interacting with Medicare can be complicated and wrought with pitfalls, which, if not understood and managed, will mire your practice in endless paperwork and frustration. We interview industry experts in every aspect of healthcare, from insurance companies, DME companies, home health agencies, medical providers, and many others, to bring you their real world expertise in the American healthcare system. Your hosts are Dr. Amy Schiffman and Dr. Alex Mohseni, two Emergency Medicine physicians who have branched off from traditional Emergency Medicine to explore and build solutions with a particular focus on eldercare and population health. Join our Facebook group: https://www.facebook.com/groups/602747270479020/ Join our Subscriber List and get exclusive access to our Mastering Medicare Cheat Sheet and other goodies: https://www.masteringmedicare.net/subscribe en-us episodic Demystifying healthcare and Medicare for senior-serving professionals and providers. Mastering Medicare What's the difference between Home Health and Home Care? How do Medicare Part A and Part B work? How do you order DME for your patient? When and how should you order home oxygen? What's new in the eldercare space? For physicians, other healthcare professionals, and senior-serving professionals, interacting with Medicare can be complicated and wrought with pitfalls, which, if not understood and managed, will mire your practice in endless paperwork and frustration. We interview industry experts in every aspect of healthcare, from insurance companies, DME companies, home health agencies, medical providers, and many others, to bring you their real world expertise in the American healthcare system. Your hosts are Dr. Amy Schiffman and Dr. Alex Mohseni, two Emergency Medicine physicians who have branched off from traditional Emergency Medicine to explore and build solutions with a particular focus on eldercare and population health. Join our Facebook group: https://www.facebook.com/groups/602747270479020/ Join our Subscriber List and get exclusive access to our Mastering Medicare Cheat Sheet and other goodies: https://www.masteringmedicare.net/subscribe no elder care, eldercare, Medicare, Medicaid, healthcare, senior care, senior, seniors, senior-serving professionals, medical care, insurance company Mastering Medicare alex@masteringmedicare.net Episode 21: CPT Codes and How You Get Paid in Medicare https://www.masteringmedicare.net/21 027b065a-1ecd-46c5-aa14-36474b19cc64 Tue, 06 Jun 2023 13:00:00 -0400 Mastering Medicare full Mastering Medicare Mastering Medicare is a podcast helping demystify healthcare and Medicare for senior-serving professionals and providers. 42:43 no Discussion topic: Getting paid through the Medicare system Introduction to CPT codes and HICPICS codes Medicare's payment process for healthcare providers Future guests and topics related to Medicare reimbursement Mention of the Aging Here newsletter and interview opportunities Differentiating between CPT codes and ICD-10 codes History and purpose of CPT codes Explanation of RVUs (Relative Value Units) and how doctors are paid Simplified process of submitting CPT codes to Medicare for payment Potential fraud issues in fee-for-service Medicare Importance of documentation and medical necessity for CPT codes Challenges with lack of comprehensive guidelines for new codes Providers struggle with the interpretation and utilization of CPT codes. Some codes are rarely utilized, while others require expertise to maximize billing. Coding rules can be complex, with restrictions on code combinations and frequency of billing. Providers face the risk of financial penalties or legal consequences for incorrect coding. Medicare is a significant payer and requires compliance with its rules. Physicians, nurse practitioners, and physician assistants primarily use CPT codes. Modifiers can be used to bill for additional services or special circumstances. Hospice CPT codes exist separately from Part B coding. CPT codes have RVUs (Relative Value Units) that determine payment. RVUs are divided into work RVUs, which assess the labor involved in a procedure. Work RVUs consider time, technical skill, physical effort, mental effort, judgment, and stress. Work RVUs are subject to negotiation and lobbying each year. The conversion factor translates RVUs into payment amounts. The conversion factor is subject to annual adjustments and can significantly impact reimbursement. Medicare, healthcare, physician, medical, senior care, eldercare, elder care, elder, seniors
  • Discussion topic: Getting paid through the Medicare system
  • Introduction to CPT codes and HICPICS codes
  • Medicare's payment process for healthcare providers
  • Future guests and topics related to Medicare reimbursement
  • Mention of the Aging Here newsletter and interview opportunities
  • Differentiating between CPT codes and ICD-10 codes
  • History and purpose of CPT codes
  • Explanation of RVUs (Relative Value Units) and how doctors are paid
  • Simplified process of submitting CPT codes to Medicare for payment
  • Potential fraud issues in fee-for-service Medicare
  • Importance of documentation and medical necessity for CPT codes
  • Challenges with lack of comprehensive guidelines for new codes
  • Providers struggle with the interpretation and utilization of CPT codes.
  • Some codes are rarely utilized, while others require expertise to maximize billing.
  • Coding rules can be complex, with restrictions on code combinations and frequency of billing.
  • Providers face the risk of financial penalties or legal consequences for incorrect coding.
  • Medicare is a significant payer and requires compliance with its rules.
  • Physicians, nurse practitioners, and physician assistants primarily use CPT codes.
  • Modifiers can be used to bill for additional services or special circumstances.
  • Hospice CPT codes exist separately from Part B coding.
  • CPT codes have RVUs (Relative Value Units) that determine payment.
  • RVUs are divided into work RVUs, which assess the labor involved in a procedure.
  • Work RVUs consider time, technical skill, physical effort, mental effort, judgment, and stress.
  • Work RVUs are subject to negotiation and lobbying each year.
  • The conversion factor translates RVUs into payment amounts.
  • The conversion factor is subject to annual adjustments and can significantly impact reimbursement.
    • ]]>
  • Discussion topic: Getting paid through the Medicare system
  • Introduction to CPT codes and HICPICS codes
  • Medicare's payment process for healthcare providers
  • Future guests and topics related to Medicare reimbursement
  • Mention of the Aging Here newsletter and interview opportunities
  • Differentiating between CPT codes and ICD-10 codes
  • History and purpose of CPT codes
  • Explanation of RVUs (Relative Value Units) and how doctors are paid
  • Simplified process of submitting CPT codes to Medicare for payment
  • Potential fraud issues in fee-for-service Medicare
  • Importance of documentation and medical necessity for CPT codes
  • Challenges with lack of comprehensive guidelines for new codes
  • Providers struggle with the interpretation and utilization of CPT codes.
  • Some codes are rarely utilized, while others require expertise to maximize billing.
  • Coding rules can be complex, with restrictions on code combinations and frequency of billing.
  • Providers face the risk of financial penalties or legal consequences for incorrect coding.
  • Medicare is a significant payer and requires compliance with its rules.
  • Physicians, nurse practitioners, and physician assistants primarily use CPT codes.
  • Modifiers can be used to bill for additional services or special circumstances.
  • Hospice CPT codes exist separately from Part B coding.
  • CPT codes have RVUs (Relative Value Units) that determine payment.
  • RVUs are divided into work RVUs, which assess the labor involved in a procedure.
  • Work RVUs consider time, technical skill, physical effort, mental effort, judgment, and stress.
  • Work RVUs are subject to negotiation and lobbying each year.
  • The conversion factor translates RVUs into payment amounts.
  • The conversion factor is subject to annual adjustments and can significantly impact reimbursement.
    • ]]>