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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. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/qr_immun_bill.pdf vanessa.moldovan@aapcnab.com
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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 vanessa.moldovan@aapcnab.com
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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

    https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html
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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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    PROFESSIONAL COMPONENT

    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
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    Question Documentation Timeline

    Good afternoon. I would recommend that you check out the OIG website. Also, I know this company https://www.ppr-corp.com/ has expert information on all things related to clinic documentation. I hope this helps. Vanessa Moldovan
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    Question Anyone having trouble with UHC denials?

    What is the denial and have you reached out to the payer?
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    Denial management coding

    Sam, I have done a lot of work in denial management for physician billing. Can you please provide a bit more detail on what you mean by "denial management coding"? And maybe some examples of what you are working on? Thanks, Vanessa
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    Question 20551 multiple units

    See attached information from AAPC Coder regarding modifier 50. I hope this helps.
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    Question Commercial Primary, Medicaid Secondary

    The rules regarding whether you can balance bill a Medicaid patient are specific per state. Medicaid is a state program, not a federal program. For example, in the state of Illinois, regardless if the provider is contracted or not, they may not bill the patient if they "accept" their...
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    Can New Patient CPT code be used?

    New Patient is determined by group or individual NPI, not TIN.
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    Question Physicians clarification of orders, is this billable and what is the coding.

    I don't think so. Was there a code you had in mind to use?
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    Getting Physician's to sign 485 Orders

    As far as I know, there are no penalties for a doctor not signing charts. It is not even a law that services must be billed. This is just a requirement if the provider wants to make money.
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    Question Balance Billing Patient - No Contracted Ins

    You do not have to follow any contract rules when you are not contracted. So you can bill the patient full charges.
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    Question Radiology Professional component

    If the radiologist works in your practice and is doing the reading, then yes.
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    Question Modifier 32

    What CPT(s)?
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    How do I know which CPT codes I can bill based on Provider Taxonomy?

    When I was billing for BH, I found the information from the state medicaid BH program had all of this information.
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    Question IOM REPORTING

    According to the code description, modifiers 26 and/or TC are not permitted with this code. I will need more specifics on the billing scenarios and denials in order to help,
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    Lab and J Code Modifier Changes

    What are some examples of the codes and denials?
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    Question Health Risk Assesment for non verbal Patients

    What CPT codes are you billing?
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    Question BH provider not credentialed with Medicare

    You have to billed Medicare for the denial before sending to Medicaid. But it is VERY unlikely that Medicaid will pay anything.
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    Question 99358

    There is no indication in the code description that there is a limit on the use of this code. If there is prolonged treatment, then it should be used.
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    Question 99152 & 99153

    What are the denials and what is the POS?
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    50 Modifier reimbursement on + on codes?

    https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1422.pdf
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    Question Billing for Shave biopsy 11102 and 87207-26 -or- 88305-26 ?

    I am unable to advise on the correct lab code without specifically knowing the lab performed. Modifier 26 is to be used when the doctor only does the reading. 99212 can only be billed if there was a face-to-face visit on the date of service.
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    Question Billing for 84153-26 and/or 99212 ?

    99212 can only be billed if there was a face-to-face visit. The modifier 26 on the lab is accurate for a read only. Vanessa
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    Revenue Cycle Expert looking for Management opportunity

    I am a performance-driven revenue cycle expert with over 10 years of experience in physician revenue cycle and coding, I can apply a unique combination of skills, education and training to achieve positive outcomes in revenue cycle processes when managing the challenges of this industry. My...
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    Is anyone actually getting replies from this site?

    I have had this same experience. My recommendation is to let AAPC know that you aren’t getting responses. It is one of the responsibilities of being an officer
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    bcbs of il 88305 and modifier 59 and 91

    This was effective 4/15/13 per Blue Cross Illinois website. Vanessa
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