appeals

  1. K

    Wiki INCIDENTAL DENIALS

    THIS MAY BE A DUMB QUESTION BUT HERE IT GOES I HAVE BEEN GETTING DENIALS LATELY THAT ARE (N19) PROCEDURE CODE INCIDENTAL TO PRIMARY PROCEDURE. AETNA MEDICARE INSURANCE, THIS CLAIM IN PARTICULAR IS A E/M WITH MODIFIER 25, WITH 69210 OVER HAS BEEN PAID BUT NOT THE 69210, FOR ME TO APPEAL THIS...
  2. M

    Wiki Weight management billing

    I do billing for a provider who considers himself a weight management specialist. His primary method is a combination of medication and weight management counseling. He also acts as a PCP for his regular patients, but his main priority is weight management. When we bill insurance, we typically...
    • mforsyth
    • Thread
    • appeals billing coding denials prevention insurance billing weight weight loss
    • Replies: 0
    • Forum: Billing/Reimbursement
  3. J

    Wiki Claim Denial: Mutually Exclusive Procedures

    Hello, everyone! I am not sure if this is posted yet. But I have a quick question regarding denials and appeals for California. Recently, we have had a denial for mutually exclusive procedures: unbundling for the codes as follows: 17000 - L57.0 AKs 17003 - L57.0 AKs 17110 - B07.00 Plantar...
  4. L

    Wiki Authorization Denials, Surgery

    Curious- Has anyone had surgery auth denials for final coding not being what was anticipated and auth'd prior to surgery that they've appealed successfully? Example: Surgery paperwork may states "Knee arthroscopy, diagnostic, meniscectomy" CPTs: 29870, 29881 called on/submitted for surgery...
  5. L

    Wiki Surgery Auths

    Curious- Has anyone had surgery auth denials for final coding not being what was anticipated and auth'd prior to surgery that they've appealed successfully? Example: Surgery paperwork may states "Knee arthroscopy, diagnostic, meniscectomy" CPTs: 29870, 29881 called on/submitted for surgery...
    • LaurenBrooke
    • Thread
    • appeals authorization billing pre-authorization surgery surgery prior auths
    • Replies: 9
    • Forum: Orthopaedics
  6. C

    Wiki Out of network billing!!

    Hello! Our practice just became in network with UHC as of June. Our effective date was 6/22/18, there was miscommunication with the rep from UHC and the person in our company who signed the contract. The person was under the impression that once the contract was signed and submitted back to the...
  7. M

    Wiki Appeals for Contractual Exclusions

    Good Morning I am a biller at a plastic surgery practice and I need alittle help with an appeal on an Emergency Room surgery that is being denied as contractual exclusion for a cosmetic procedure that the patient had over 10 years ago. The patient presented to the ER with severe back pain...
  8. E

    Wiki Medicare Denial CO 97 and Denial CO 151

    How do you appeal Medicare Denials CO 97 and CO 151
  9. B

    Wiki Appeal techniques for OON claims

    One of our providers recently decided to go out-of-network with major insurance companies. I'm looking for some tips on what to include in our appeal letters to these payers for increased reimbursement. We are mentioning: FAIR Health rates for our geographical area Relevant aspects of the...
  10. R

    Wiki Looking for FT person experienced in follow up and appeals in Tucson, AZ

    Our office is in search of someone knowledgeable in insurance billing follow up and the appeals process that is able to work Fulltime. The physician group is great and we are growing, adding 2 new physicians by the end of the year. Reimbursement is very competitive and the work environment is...
  11. M

    Wiki RN, CPC-A seeking local or remote HIIM position (Nashville, TN area)

    RN with a Master's in Nursing Informatics with a CPC-A seeking a leadership position locally in an HIIM department. STEPHANIE CLARKE-MAHONEY REGISTERED NURSE, BSN, MS, CCM, CPC-A 812 COLLIERS BEND ROAD CHARLOTTE, TENNESSEE, 37036 RNCODERCCM@GMAIL.COM (615)495-2265 OBJECTIVE Registered Nurse...
  12. ljones88

    Wiki New CPT codes being denied by commercial carriers

    Hi all, We recently came across a few claims denials with Coventry. They are denying 92537 and 92538 as non-covered. Of course we have reached out to our provider reps to inquire when Coventry will have their systems updated but we are still pending a response from them. For now, we're sending...
  13. E

    Wiki A/R specialist looking for position in LA, SFValley CA

    I have many years experience of collecting on A/R, re-billing and corrections of CPT and ICD-9 codes. I am intresting in a position in Los Angeles or San Fernando Valley, Brentwood, Beverly Hills. I am CPC certified and have certificate for ICD-10-CM profiency. Eivor Nordstedt Phone...
    • eivor
    • Thread
    • accounts appeals billing medical software
    • Replies: 0
    • Forum: Resume Postings
  14. jocarter

    A/R question about writting off claims that are being appealed

    Is it a normal practice to adjust off a balance at 90 days, even if the claim is pending an appeal/redetermination? I am finding multiple examples where documentation clearly supports the charges, so we should be getting payment. Any feedback on this would be greatly appreciated. Merry...
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