Billing Consistantly to all insurance companies

petersonkara

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Does anyone know what legislation states to bill consistantly (the same codes) to all insurance companies even if you know they will not pay. I am trying to show this to someone in my billing department. I believe we can append -00 modifiers to show we do not expect payment but we should be billing the code. They only want to bill the code to the one payer who is paying. Can someone please help me?
Thank you so much!
 

btadlock1

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Does anyone know what legislation states to bill consistantly (the same codes) to all insurance companies even if you know they will not pay. I am trying to show this to someone in my billing department. I believe we can append -00 modifiers to show we do not expect payment but we should be billing the code. They only want to bill the code to the one payer who is paying. Can someone please help me?
Thank you so much!
Go here: http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/EducationMaterials/Downloads/Whateelectronictransactionsandcodesets-4.pdf

What you want, is on page 4. Word to the wise, though - you don't always bill every insurer, the same way. CPT, HCPCS, and ICD-9 code sets are part of the transaction standard (meaning, those are the only codes recognized for billing physician services), but only ICD-9's guidelines are mandated, as part of the uniform standards. Payers have enormous flexibility to interpret and even create guidelines, for using CPT and HCPCS codes, and modifiers.

Most (but not all) commercial payers tend to follow the same rules as one another, Tricare (usually) follows Medicare's rules (which are often completely different from commercial), and Medicaid makes up its own rules, on a state-by-state basis. You should bill each carrier, according to their own guidelines. (If a patient is double-covered, go by the primary payer's guidelines.)

For example, in my state, there are 4 ways to bill for testing for Influzenza A & B strains:
87804, 87804/59 = some commercial payers
87804/QW, 87804/QW59 = Medicare, and other commercial payers
87804/QW, 87804/QW91 = Texas Medicaid
87804 x 2 units = Tricare
If we tried to bill every payer the exact same way, we'd be inundated with denials, because we would only be following one payer's rules, which aren't applicable across all payers.

Hope that helps! ;)
 

petersonkara

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You always seem to have the answers!! Thank you SO much! I know sometimes we have to change the codes for the different payers but she is not wanting to charge for services we provide. I am trying to explain to her that we cannot pick and choose to bill certain things to one payer and not the other. And then charge it to private pay clients.
The specific situation right now is for the code Q3014- Telehealth origination site facility fee. My biller states Wellmark is the only payer that will pay so she will not submit the charge to other insurance companies.
I appreciate your quick response and assistance. I am trying to find something somewhere that states you have to bill equally. I looked at what you sent but I didn't see that.
Thanks again!
 
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