insurance

  1. A

    Question How to bill source patient labs to workers compensation insurance?

    I work for an Occupational Health clinic in Illinois and we are trying to figure out how to bill bbp exposure source patient labs to workers comp insurance. These labs were not drawn from the claimant but from the patient whose blood the claimant was exposed to. Does anybody have any information...
  2. M

    Question Molina is automatically downcoding office visits without requesting medical records.

    I do billing for an internal medicine physician who specializes in weight management. Most of his visits are coded as 99214 or 99215 + 99401 or 99402. We do not have a lot of Molina patients, but of the ones we do have, every single claim gets downcoded from 99214 to 99213. We do not receive a...
  3. lindsey.motter

    Question CPCO or ...

    Good morning :) I accepted a role within my company, and will be working with HEDIS/STARS compliance. Would the CPCO exam be appropriate, or is that more auditing related?
  4. morriam91

    Question Visit billed on wrong DOS

    I am currently having an issue where our biller is posting the patient's visits to the wrong date of service. Example: Patient was seen on 5/4/21, but when the charges are entered into the system she by mistake puts the date of service as 5/14/21. I have a handful of claims that have been sent...
  5. D

    Can you pick and choose what you bill?

    Hey, Is a physician required to bill for the services that he or she performs? Example: Established patient receives an injection ( 20550 ), an ultrasound (76882). Is it possible to not bill the carrier the 20550 and do a 99213 instead since you cannot bill a OV on the same day you bill a...
  6. D

    Referral Carolina Access - Medicaid NC

    I know standard Medicaid does not require a referral and I understand that Carolina Access does for a specialist. My question is does the referral have to have an authorization number on it? I thought it did and when I called the PCP and asked for one I could feel them stare at me through the...
  7. eharloff

    CMS-1500 Question - PA

    For Box 31 on the CMS-1500 Form, if a patient sees a Physician Assistant, does the PA's name go in that box or does it have to be an MD or DO? Any help would be great! Thank you :)
  8. eharloff

    Depression Screen

    I have a quick question regarding depression screening. So this patient came in for her CPE, we did a depression screen and billed it 96127, G8510, her insurance adjusted $12.74 off and is leaving $5.26 toward her deductible. My question is, can we bill this to her or do we write it off since...
  9. eharloff

    Denied Medicaid Claim

    First off, I absolutely hate Medicaid with a passion (lol) I'm located in Michigan and I received a denied claim Adjustment Reason Code 16: Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other...
  10. M

    Coders for Insurance Companies

    Good Morning! I work for an auto carrier in PA as a coding supervisor. The question came up as to what other types of insurance companies employ coders, and what type of responsibilities those coders have. I supervise a team of coders that audit the medical claims that are billed to us for...
  11. P

    Question Medical Records requests

    I am very new to Medical Billing and Coding and recently started a new job. A request came in from an insurance company asking for medical records on a patient for a very wide date range. It stated they were looking for pre-existing conditions. My question is can they do this, request medical...
  12. K

    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...
  13. J

    Eligibility Verification

    Does anyone have any good advice on the best way to set up auto-eligibility verification? Any examples of software applications that are really efficient? We are wanting to have an automated process that will generate a report for our persons served receiving Medicaid coverage. We are located...
  14. H

    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...
  15. E

    Insurance refunds

    Hello, I was wondering if there was someone who has great experience in dealing with this? We don't really have a protocol set in place and normally allow the insurance to recoup when applicable. But I'm wanting information on how to handle the claims that were truly over paid and insurance...
  16. S

    Making patients self pay vs billing ins

    Some staff in our office have contradicting opinions... Background: Our office doesn't accept new patients with a "xyz" insurance. But we are in network with the insurance and file for our current patients only. If a patient was originally a self pay patient, but now has "xyz" insurance...
  17. B

    Need modifier

    Hi Here I am getting wrestle to fix the below mentioned claims... Now I am frequently getting denials with the CPT H0023 as “missing modifier” from Medicaid insurance. I am new to see this HCPCS code, please give me your suggestion on this
  18. G

    Medical Marijuana Billing - Illinois?

    I have been approached by an MD, in Illinois to help assist in billing medical marijuana to insurance companies. Currently they are charging a flat rate, per patient and not billing insurance companies. I have researched & found that majority or NO insurance company is reimbursing for a patient...
  19. K

    Float Tank coding

    Has anyone had any experience with this type of therapy? Do you know what code would be appropriate for Float Tank/Isolation Therapy. Here is a link that describes what the float tank is https://www.youtube.com/watch?v=P3sfGfPFDxU or http://en.wikipedia.org/wiki/Isolation_tank. CPT 97022 kind of...
  20. H

    ICD10 Global ob billing

    With the new year and so many patient's changing insurance, we have to bill ob visits from 2015 to one insurance, not included in global. We are having trouble with some insurance companies denying our claims even though we are billing semester and weeks gestation as dx code.
  21. B

    holiday codes

    Our physicians want to bill cpt code 99051 (open during federal holiday code). I know insurance companies are not always going to pay, but I was wondering if anyone has had any experience in billing this code and do you notify the patients before their visit that there is an additional charge...
  22. D

    Insurance Verification/ Medicare & Medicaid

    Part of my new position aside from coding is demo and insurance verification. For verifying Medicare and Medicaid aside from replacement policies. Is there a main website for Medicare and Medicaid to verify coverage with out having to get into separate state sites? If anyone has any info I would...
  23. O

    Durable Medical Supplies

    Our small clinic is looking to offer DME (splints, braces, crutches etc.) for our patients to walk out of the office with. Is it legal to bill different insurance carriers, different prices based on their reimbursement? Thanks you.
  24. R

    I have CPC, COC with over 10 years of exerince looking for a job as a coding manager

    ROZITA POURMOUSSA, CPC, COC E-mail ablemed@hotmail.com (818) 489-9207 Objective: To obtain a challenging and rewarding position, and to be able to utilize my education, experience as Certified Professional Coder, and Certified Outpatient Coder. Qualification: Certified Professional Coder...
  25. R

    Coding for screening of tobacco

    We are beginning to do urine nicotine testing. That is all they will be coming in for. Patients need to turn this in to their insurance to receive discounted premiums. Does anyone know what ICD-10 code would be best to use? Thanks
  26. C

    Hearing Aid DOS Question (return and re-dispensed)

    Hi, what is the correct date of service to bill insurance for a hearing aid supply? A patient got hearing aids which commercial insurance paid in full, but patient returned the hearing aids within the trial period. Different hearing aids were ordered and given at a later visit where we charged...
  27. L

    PLEASE HELP with Radiofrequency denials

    I work for a pain clinic and my doctors perform radiofrequncy injections. I believe we are billing them correctly 64635x1 and 64636x2 when three nerves are injected. However we have ran into issues with an insurance that is denying the additional unit and stating we can only do two (64635x1 and...
  28. C

    Insurance

    Has anyone purchased insurance when working as a contract remote coder? Is it necessary?
  29. K

    96413 verses 96365

    Can someone explain the difference between 96413 & 96365? We administer infusions of drugs such as Remicade, Actemra and Orencia. We have always been told to bill 96413 to Medicare and 96365 for all other insurance companies, but we are now having some debate about whether we should be using...
  30. M

    Avastin for Medi-cal

    I am trying to Bill Medi- Cal for avastin. They are denying my 92134 and J9035 stating that codes are not payable with DX i am using. I am using E10.39 and E11.311, Does anyone know, how it should be billed? I dont have any problem getting paid with any other insurance, but Medi-Cal (of course)...
  31. L

    Receipt of EOPs in error

    We have electronically received numerous EOP's intended for a provider in another state that we have NO affiliation with. None of the patients are any we have ever seen. Some were viewed before the error was found. Is this a HIPPA violation? Need I do anything specific in notifying the insurance...
  32. C

    insurance change in maternity

    We have a patient who switch insurance first she had 6 visits with first insurance. we billed 59425... with her new insurance she was seen 8 times plus delivery and post partum . can we billed global to her new insurance?
  33. S

    New Technology Procedures/Services

    Hi, I'm wondering if its appropriate for a provider to offer new technology services and materials to patients on a cash pay basis if codes and fees have not yet been assigned? I know unlisted codes are available but with no set fee you run the risk of insurance reducing reimbursement sometimes...
  34. T

    Non global package

    We had a patient (she has Molina insurance) seen on 7/15, 8/15, 9/8 and 9/22 and then 4 more times in October. How are we suppose to bill for dates of service before October 1st?? Do we bill as a low office visit. Insurance companies want ICD-9 and ICD-10 codes on different claims. I don't think...
  35. M

    Billing for Telemedicine

    I have a question regarding billing for Telemedicine. My primary care health provider is looking at doing Telemedicine. We are looking at doing it for Maryland residents (as we are a Maryland practice) and I have already done some research into which insurance providers do allow billing for...
  36. D

    skin tags/another request for help

    I had posted this on 1/11/2016 and got lots of views but no posts. Can someone help me? I think the secondary diagnosis should be R23.8 because the skin tags were being irritated by her clothing. Here is my previous post:Person had skin tags removed- CPT 11200. The diagnosis code used was L91.8...
  37. P

    Workers Comp vs Commercial Insurance CPT pricing

    Need some advice: Can a clinic charge different pricing for WC CPT codes vs. Commercial Insurance? Basically, have two fee schedules for our CPT codes. Thanks PK
  38. D

    skin tags - Person had skin tags

    Person had skin tags removed- CPT 11200. The diagnosis code used was L91.8 Skin tags, multiple acquired but secondary code was being required by insurance. Added secondary code L08.89 other specified local infection and insurance denied again. Can someone tell me what diagnoses should be used to...
  39. M

    New Patient Who Was Once Established

    If we have a patient return to office that hasn't been seen in 3 years- we bill them as a new patient. Does this mean they also have to complete all new patient paperwork? Or can we obtain all information verbally? Such as, insurance, address, phone number, past medical history, surgeries and so...
  40. M

    Does new insurance mean new patient??

    I was told by a provider that when a patient obtains a new insurance, they are billed as a new patient (regardless of when they were last seen). The provider agrees that if someone hasn't been seen for three full years that they are a new patient. However, they have also been told that even if...
  41. C

    Cpc-a, icd-10 proficient searching for remote position

    Hello, my name is Chelsea (CPC-A, Proficient in ICD-10) chelseamoore1@live.com I received my coding/billing license through AAPC in 2013. I maintain my license by obtaining the appropriate CEU's. I am fully up to date. I have less than 1 year experience in office coding and billing. I am looking...
  42. S

    HIPAA rules

    Can someone tell me if we do not have the patient's signature on the HIPAA form, are we able to go ahead and bill his insurance? He did give us his insurance information, we just neglected to get his signature on some forms.
  43. J

    Wiki Cms-1500 form

    Does anyone know how to get a payer to consider 2 pages of a HCFA (more than 6 charges) under the same claim number? A coworker suggested not filling out boxes 28-30 on the first page, and that way the insurance would have to combine the 2 pages together to get the correct total, I'm just not...
  44. M

    OB Global Billing

    Hello Joan Smith started her insurance coverage shortly after she found out she was pregnant. Joan saw the same doctor throughout her pregnancy, delivery and postpartum care. The catch is, Joan's health insurance covers antepartum and postpartum care, but imposes a preexisting condition...
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