billing

  1. S

    Wiki Tax id for a nurse practitioner's office

    I hope i get clarification with my dilemma and thank you for any help. When a NP opens independent private office, does NP need to get a TAX ID for business? or can SS# be used on claims for place of service [11]? Claim line# 32a
  2. C

    Wiki Contract Billing and Credentialing from Home

    Certified Coder and experienced billing and credentialing from home. Current knowledge of navigating current, complicated billing procedures and guidelines. Would love to talk to small, independent practice. If in the Dallas area, would be available to meet regularly in the office.
  3. C

    Wiki 36475 & 36476 Veins / CMS billing

    Hi. We've been getting a lot of zero pays for add-on code 36476 when it is billed with 36475, both from Medicare and some other commercial payers. I think part of the problem is on the 2018 CMS Fee schedule, there is no amount listed for 36476. (This is also the case the 37799, where we are...
  4. J

    Wiki Billing California Medicare Facility Charges

    We are billing for an ASC in California, and having either the facility or professional charges deny as a duplicate charge. We own the ASC so the tax ID is the same. We have contacted Medicare, their suggestion has been to just appeal the denial or add a 77 modifier. This does not seem like...
  5. C

    Wiki When all the procedures don't fit on the claim form

    Good morning everyone, I've been an avid reader of the forums for some time and would appreciate some advice on a thorny work situation. The practice I work for has decided to change up some of the lab testing. The problem is what they want to change it to is basically 3 components short of a...
  6. K

    Wiki PLEASE HELP-discrepancy between name on id and name on insurance card

    If a new patient comes in and their ID says their name is John Bob Doe and their insurance card says their name is Bob Doe, how do you handle this? I have always billed under the name that is on their ID as this is their legal name but I keep seeing posts that say offices change their...
  7. K

    Wiki Billing S codes to the VA?

    Hello, I do billing for a home health agency and I am rebilling some old claims to the VA. I found some claims that are for home health aide services. Some of the claims are being billed as S9125, respite care in the home, per diem, and some are G0156, services of home health / health aide in...
  8. D

    Wiki Deana

    I recently received a remittance from Noridian Medicare (Hawaii) Part B. One of the claims that was processed on the remit had an additional adjustment I had never encountered previously. This patient has a dual plan. Medicare/Medicaid. Enrolled with straight Medicare and has HMSA (BCBS of...
  9. H

    Wiki Eyewear coding for Insurances

    I was wondering what resources anyone knows of out there for eyewear coding for routine eyewear. I am looking for a resource that can help me give the office I work for examples of how to code glasses. Until recently they were more self pay, and now with so many patients having vision insurance...
  10. R

    Wiki Incident to billing scenario

    A nurse practitioner sees a Medicare patient for the initial visit and sets up a treatment plan, billing under them at 85%, because there was no supervising physician on-site. The patient returns for a second visit to see the nurse practitioner, but this time there is a supervising physician on...
  11. W

    Wiki FQHC billing/services question

    Hello- I am writing from a clinic that is about to merge with a FQHC look alike. We will begin billing under the FQHC look alike's status and will receive the PPS rate for eligibile visits. Probably not necessary to say, but I have questions around what this looks like from a billing &...
  12. K

    Wiki Is this fraud??? Help!!! :(

    This might belong in the coding forum, but I'm just going to post this here. So something has come up at my place of employment and I'm wondering if this could be insurance fraud. I'm certain it is, but I'm looking for other insight. I was reviewing some A/R and we have some really old unpaid...
  13. Y

    Wiki Reference Lab Billing-Admission Source

    Hello, I bill for an OON hospital facility. We just contracted with a reference lab to perform billing for out patient lab services. Lab billing is completely new to me and I'd greatly appreciate any help I can get. I am currently having doubts about the admission source. What admission source...
  14. D

    Wiki Looking for opinions on capsule reading and billing global

    Good Afternoon All, If a provider is buying the capsule cams, has the download center equipment and is paying someone to read their capsule but then reading it themselves and signing the note that the provider read the test; would this be allowed in order to bill globally? I was told if the...
  15. R

    Wiki Yearly physical done by one provider and Pelvic and Pap done by another on same day

    Hello, I have a question. If a provider is doing a yearly CPE and during the CPE calls in another provider within the group to do the Pelvic and Pap because the patient required a female provider to do so, can we bill the provider who did the CPE for the year physical and the other provider just...
  16. S

    Wiki Billing Medicaid first for medical or billing Medicaid Amerihealth first

    I'm new to billing and coding. When patient has both, which one do we bill first for a medical Dx, medicaid Avesis or Medicaid AmeriHealth? :p
  17. R

    Wiki Experienced professional coder looking for part time (<20h/wk) remote

    I am an experienced CPC with over 15 years' experience. My coding experience ranges from primary care (Fam Med, IM, Peds), to specialties such as ID, OBGYN, and ED. My resume is attached. I am willing to work remotely up to 20 hours per week. My contact information is in the attached resume...
    • rigdon72
    • Thread
    • billing claims obgyn payment posting professional coder
    • Replies: 0
    • Forum: Resume Postings
  18. J

    Wiki Medication infusion and hydration billing

    Good evening, I would greatly appreciate any advice on the following topic: In the oncology department some patients receive hydration as well as their medication either due to dehydration, or due to the renal toxicity of the chemo. Hydration is given per the doctor's order. Previously our...
  19. L

    Wiki Billing/coding/modifiers

    I work for a small 150 bed community hospital. Our billing office contacted me today about a VA denial we received. We use the 3M encoder and it is setup to group following Medicare guidelines. My biller said the VA follows Medicare guidelines, BUT they are "behind" on being up to date with...
  20. H

    Wiki CPC with 1+ year of experience, multi-specialty, midwestern Illinois

    Completed credentialed AAPC Medical Billing and Coding Program in July 2017. Earned CPC in June 2017. Willing to travel initially if there is a possibility of position becoming remote. Otherwise looking for a position located in midwestern Illinois, southeastern Iowa, or northeastern...
  21. J

    Wiki PT/OT/SLP Evaluations

    I bill for Pediatric (Birth to age 3) OT/PT and Speech Therapy. I was asked recently about evaluations that aren't completed during a single session. The problem we have, is most of these kiddos can't make it through a session that is long enough to complete the entire eval. The therapists will...
  22. K

    Wiki Medicare PT and OT, different offices, different days

    Quick compliance billing question for a Medicare patient. He is currently receiving outpatient PT at our office for Parkinson's related weaknesses/pain. He also just started seeing an outpatient OT for Parkinson's related weakness/dysfunction. Will Medicare pay for two outpatient offices to...
  23. A

    Wiki Twins: Vaginal birth then C Section. How to bill.

    Hospital billing for a pt that had twins; delivered baby A vaginally and then baby B via C- Section. Which modifier would be most appropriate? :confused: Thank you!
  24. 1

    Wiki Billing Issues

    Hello, I am looking for a little help from anyone who might have already had this same scenario before. I have someone who has is having an ESWL-50590 and they ended up having 2 stones treated in 2 separate locations on the same side-RT. One of the stones is a staged procedure from a previous...
  25. S

    Wiki Billing 64405 DX M5481 to BCBS Denied

    We bill 64405 (greater occiptal nerve block) with DX M5481 (occiptal neuralgia) to Blue Cross, they deny stating non-covered. When patient contacts BCBS, they advise patient, denial is due to the diagnosis we are billing. However, M5481 occiptial neuralgia is the reason for the occipital nerve...
  26. S

    Wiki Medicare Set Aside Exhausted - Private Insurance Required Auth

    Has anyone else had a patient with a third party administering the patient's Work Comp Medicare set-aside account, and the funds became exhausted, and your office was not notified? This company actually issued an EOB, but never funded the amount allowed on the EOB. The additional issue here is...
  27. ronaldgfell

    Wiki Need Definitive Answer to when to post procedure

    Hello to those Gastro Coder/billers... I have been coding Gastroenterology claims for EGD's/Colonoscopy's and also Impedance Monitoring, Esophageal Monitoring, Esophageal Function Tests, Antrodudenal Gastric Manometry, Duodenal Manometry, and Colonic Manometry. It seems the coder/biller prior...
  28. T

    Wiki Help me choose my frist coding job.

    Hello, first I thought I should tell you all my experience, then what the jobs are and what they offer, then the problems I see with each. This would be my first coding job and I just really want it work out well. So first I want to say, everything I know about coding I taught myself. So I feel...
  29. R

    Wiki Recommendations - Best RCM Billing Software

    Hello, Looking for recommendations/reviews on a good revenue cycle management billing software. Will be integrating in with a pre-existing EMR for a large behavioral health practice. Considering an old version of Centricity we already have on hand but I wasn't sure if there was something...
  30. S

    Wiki Downcoding Lab Services

    We are an independent lab. Humana and Cigna now have policies in place that they will not reimburse any higher than a G0480 tox for Humana and a G0481 tox for Cigna. What Cigna does is downcode when they reimburse and Humana pays the higher tests than recoups a couple months later and we have to...
  31. C

    Wiki Grant funding vs Using insurance

    Hello, I work for a nonprofit mental health center that accepts insurance but is largely funded by grants. I am having a hard time getting straight answers from our contracted payors (insurance companies) so I am looking for some guidance to balance grant funding for services where the client...
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