Recent content by ejlehman

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    Humana denials

    Humana never paid exams for us. They always told us "they follow Medicare guidelines" for E/M.
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    Does anyone know of any chiropractic seminars ?

    Both Chirocode and Chirotouch offer webinars that are very up to date and informative.
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    Sample claims

    I am teaching a Health Insurance and Reimbursement course at YTI and am looking for some sample notes/insurance info for students to practice filling in the claim forms. I can only do so much from my office as I am in a specialty so am looking for a variety of types of cases, payers, etc. We...
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    Template for 98940-98943 Medicare

    Check your local LCD. Also check for your EHR guidelines if that is what you are using. With the upcoming changes for 2017, you're going to want to know.
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    Chiropractors Billing Massage

    We have a LMT in our office and none of the payers will pay for it when she bills. They will let the patient use their HSAs for the massage. Stick to your guns. If need be, contact the insurance company and have them send out guidelines that you can copy to your patient.
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    E/M with CMT

    If you are billing E/M with a CMT code, it must be for a new condition or a recurrence with acute onset. Make sure you bill with a modifier. If more than 50% of the visit is spent in counseling, then you can bill an E/M as long as you document the time factor. The CMT code normally includes...
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    Chiropractors

    You can bill but it will be denied as Medicare does not pay it. I will bill for it so that when it crosses over to the secondary (and especially if the secondary pays for it) it is there without doing a separate billing. Many of our patients want to see that denial before they will pay it out...
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    Aetna and denials for ICD-10

    Not all claims. I am in chiropractic so I use the M99 codeset per CMS and LCD guidelines. I have some that have gone through without an issue but I have more that are being denied. I cannot seem to get a straight answer when I call about them. So frustrating.
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    Aetna and denials for ICD-10

    Is anyone else having issues with ICD-10 and Aetna? I am in Pennsylvania and we keep getting denials for incorrect coding. I know they are the right codes as no one else is denying them. Any insight would be great!
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    New to Chiropractic

    Did he use the modifier -AT? Does he have an ABN on file for those patients? He can appeal for a code 50.
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    Resources for Chiropractic care

    CMS has a list of ICD-10 codes that are accepted (much like the list that they provided for ICD-9). Chirocode has a bunch of great webinars that will help. Also the state chiropractic association should have something available. I know we are having issues with Aetna and ICD-10 but all other...
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    auto accident and transportation

    Check your state laws regarding this. Each state is different.
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    Orthotic Billing For a Chiropractor

    We bill for orthotics in our office. Check with your payer to make sure it is payable to your office or how it should be billed. Make sure your dx supports the need for orthotics (usually unequal leg length).
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    documentation requirement for CPT 98941

    With the coming of ICD-10, it is best to encourage the doctor to be specific and document where he is adjusting (region, vertebra, and direction). I have had a few audits that this has been questioned. Many payers are asking for notes more and more and it is best too have too much than too little.
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    bundling?

    We bill 98941 and 98943. No modifier unless it is Medicare. Medicare does not pay for extra spinal and some insurance companies do not also. Check your contract and guidelines.
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