Recent content by casseciella

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    Employer

    Has anyone heard of Sage Moon Zenterprises LLC? If so, can you provide any feedback about the group....
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    Credentailing - Closed Network

    Thank you! We have appealed to explained how our testing is different, but I guess it is not different enough. So I was just trying to see if there was any other option. Thank you!
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    Credentailing - Closed Network

    Hi Dana, Thank you for your response, however I wasn't referring to denials on EOBs/Remits. I am referring to not being accepted into a payer network as a PAR provider. The reason that we always seem to get is "their existing network is comprehensive to meet the needs of our customer." So I was...
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    Question Any idea what "PR-106 - Patient payment option/election not in effect" means?

    I would suggest the patient hasn't paid their premium, i worked at BCBS for 6 years, and if that is the case, they typically won't come out and say it. DO you know if is an individual purchase plan? If so, based off the wording in the denial, it just sounds like the patient hasn't made their...
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    Credentailing - Closed Network

    Can anyone give advice on how to appeal/overturn a payer having a closed network? I work for a laboratory, and it seems almost impossible for payers to accept us because they always say the network is closed; "their existing network is comprehensive to meet the needs of our customer", is...
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    Question Lab DOS

    When working at an outside lab, do you use the collection date as your DOS or the date you received the specimen as your DOS?
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    Lab Advanced Beneficiary Notice (ABN)

    Lisa, I am not aware of a list those shows ALL codes that are or not covered by CMS. M advice would be to just search for the codes your office bills.
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    87798 Billing Multiple Units

    E. Coli, Clostridioides Difficule (c.Diff), giardia, salmonella, etc. just to name a few...
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    Writing note in books for exam

    In my opinion, you will probably be fine. As long as there no LONG passages, generally they just quickly flip through your book, so as long as it's not something that sticks out loudly, I think you might be okay. I would be sure to make them look like notes, whether than making it look as if you...
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    87798 Billing Multiple Units

    I was wondering are you billing 87798 instead of 87505-87507? Or, what is your opinion on billing 87798 if we are only looking for ONE organism that's offered in 87505-87507?
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    Opinions Needed

    Instead of billing 87505-87507, could we bill 87798 if we are only looking for ONE organism offered in 87505-87507? thanks!
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    discount vs self pay

    Can you provide a discounted rate for payers who are out of network, but ALSO have a self pay rate for patients who are uninsured? Thanks!
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    Abn

    can someone refresh my memory... if a patient signs an ABN and then the services are denied, do we bill the patient up to Medicare allowable or can we give them a discount rate?
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    Medical Documentation

    Thank you for your response! I understand that the provider should supply the dx, but long story short, we bill certain CPT codes that are only covered with certain dx codes. Therefore, if I can provide some guidance to the providers to see if they can select A04.8 vs R19.7 (if there...
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    Medical Documentation

    Can anyone assist with where I can find chart documentation for an ICD-10 code, for example I am looking for the criteria that would need to be met in order to bill A04.8 Chart documentation for this code must include: ?? I work at a lab, so I do not have direct access to the patient's...
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