Recent content by vanessamoldovan

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    Question Claim becomes timely due to member providing incorrect insurance information

    In my experience, the patient can successfully appeal this with the payer. The payer will usually not care what the provider appeals. As far as whether you bill the patient or not, that depends on the payer contract guidelines and internal office procedures.
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    Question Modifiers

    See attached from AAPC Coder Claim Edits Checker
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    Question Billing 93298 without visits

    Please see attached information. If this isn't helpful, I would recommend reaching out to your MAC.
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    Question Need help with 90741

    Please note the information in the link below that indicates the approved Medicare codes for immunization.
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    Setting Fee Schedule

    In my experience working with physician groups and private practices, the fee schedule is set between 150%-200% of Medicare and then there is a separate self pay/OON fee schedule which is usually a percentage of the practice fee schedule. I hope this helps. Vanessa
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    Question Billing PA's and Radiology - Novitas MCR

    I believe you must check with each MAC to determine what their policy is.
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    Question 20610 4 major joints

    Iveburg, What is the denial reason and what are the MUE guidelines for this code? Vanessa Moldovan, CPC, CPMA, CPPM, CPC-I
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    Patient termination from practice

    Maricela, If the patient has a government insurance plan, I recommend that you contact the carrier to find out what steps they require. If the patient is not on a government plan, you can refer to information on the OIG website. I hope you find this information to be helpful. Vanessa...
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    Question claim denials

    Chelsa, I would agree with the previous post, as well. There are multiple reasons that the charges for the professional services would get paid and the ASC wouldn't. Would you mind providing a sampling of the types of denials you are receiving? Vanessa Moldovan, CPC, CPPM, CPMA, CPC-I...
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    RN Reimbursement

    If the provider is credentialed with payers, then they can be reimbursed per the payer guidelines. Vanessa Moldovan
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    mue's prior to july 2019
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    Question Global Fee Periods and Reduced or Discontinued Procedures (Modifiers 52 and 53)

    This is a really great question! Modifiers 52 and 53 have no effect on the global period of a procedure. That being said, I am curious about how you got started down this road of research? Did you receive a particular denial? Did a provider inquire? Would you mind sharing more information...
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    It looks like your modifiers are correct. If you feel that the work the provider performed for the 75574 should be considered separate from the 99284, then I would recommend appealing. But if the documentation does not support it being a separately identifiable service, then there are no...
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    claim rejection and denial help wanted

    I am looking for some part time work and would be interested in this opportunity. Please see my attached resume.
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    Question Wellmed need unbundled modifier

    Can you please provide additional information on the denial that you are receiving and the information from WellMed stating to bill without modifier 59? Have you tried billing without modifier 59 to see what happens? Vanessa Moldovan