Billing Medicare Secondary Payor ClaimsBilling Medicare Secondary Payor ClaimsMedicare Secondary Payor forms can be filled out at the time of service in the case that Medicare doesn't have the SCD Secondary Claim Development Questionnaire form. Learn to get paid when Medicare doesn't have one on file 
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Medicare Crossover has new edits - learn more
2007-03-21 02:52:00 Have you been having issues identifying why claims were denied prior to the crossover? If so you can read the attached Medicare document to identify how Medicare is now resolving this issue.http://www.cms.hhs.gov/MLNMattersAr ticles/downloads/MM5472.pdf More About: Cross , Care , Earn , Edit , Over
Websites for Doctors
2007-03-10 23:07:00 More and more patients are looking for doctors on the internet. Health insurance carriers like United Health Care, Blue Cross Blue Shield & Humana list all credentialed/contracted providers on their website which gives doctors an option to post their web-sites.This is very useful and usually results in more referrals to the office. It's wise for doctors to get a website and maintain it. My suggestions are to focus on a clean web-site with friendly pictures. Have the option for patients to download new patient registration forms to have filled out prior to arriving in the office.Some software companies now have the option for patients to schedule their own visits and pay their co-pays, deductibles and co-insurance at any time over a secure internet web-site. Search for new features that may actually make your front office work-flow smoother.The first step to getting a web-site is to identify a Web Hosting software with online web hosting services for hosting software. Next you will ... More About: Doctors , Website , Site , Websites , Webs
Premera Blue Cross Dental update
2007-03-10 20:02:00 Starting in 2007 Premera Blue Cross will no longer accept CDT procedure codes that start with the number 0. Submit all CDT procedure codes starting with D as specified in the 07-08 CDT published by the American Dental Assoc.If you are looking for Dental insurance please visit: Dental Care Search, compare and choose from more than 30 national and regional money-saving discount dental plans. Take the firststep toward a healthier smile and start saving today! More About: Update , Ross
Sinus and Allergies
2007-03-10 19:55:00 Are you tired of having sinus and allergy issues? It has been estimated that between 30 - 40 million individuals in the US suffer from chronic sinusitis. About 350,000 procedures are done in the US for Chronic Sinus itis.Normally a patient has symptoms of difficulty breathing through the nose, tenderness in the face around the eyes and nose, and the worst is frequent headaches. Allergies are a common cause for this illness along with mold or fungi in the sinuses.New patients to a Sinus facility are usually treated for the Evaluation and Management along with an endoscopy. The biller will bill the E/M code 99241-99245 along with the sinus endoscopy procedure codes like 31231 – 31294. When billing the endoscopy procedure codes are considered unilateral. Please remember to continue to include the 50 bilateral modifier if appropriate.To learn more about having clean air in your home which may possibly be causing your allergy issues please visit: Furnace Air Filters Here's a review of ...
Medicare as a Secondary Payer - Liability Situations
2007-03-06 03:22:00 MEDICARE AS SECONDARY PAYER (MSP) - LIABILITY SITUATIONSWPS Medicare understands that there can be confusion in the provider community about billing Medicare or a liability insurer. Providers also are unsure of what amounts they can collect from the patient when a liability situation exits.If a provider is aware that a liability situation exists, the provider should bill the liability insurer first within a 120-day "promptly paid" period. If the liability insurer does not make payment within this timeframe, the provider has a decision to make. The provider can bill Medicare or pursue the liability claim.A provider choosing to bill Medicare would bill the charges as usual. Providers not accepting assignment can collect amounts up to the Limiting Charge. Providers accepting assignment can collect deductibles and coinsurance amounts. The provider cannot pursue a lien or claim against the liability insurer or the beneficiary for amounts collected from the liability insurer.A provider ch... More About: Care , Second , Bili , Econ
Billing Secondary Insurance Claims Electronically
2007-03-06 02:47:00 Being a Medical biller in this day and age has some really cool options. My new found favorite is billing my secondary claims electronically. No more having to print the primary EOB and attaching it to the secondary.Each state has different carriers that allow secondary claims electronically but the big ones like Medicare, Medicaid, United Healthcare and Blue Cross Blue Shield are accepting them. Call your local insurance carriers to identify if they accept it.In my Medical Billing Software it's as simple as 4 clicks to turn this feature on. And everyone's biggest question is how does the primary EOB get attached to the Second ary claim. Well, it doesn't get attached - paper claims are so different from electronic claims. The electronic claims can transmit so much more information but in lamens terms the claim goes out with the following:Box 28: Total ChargeBox 29: Amount Paid (this would reflect what the primary insurance paid)Box 30: Balance DueThis means it's the biller's res... More About: Electronic , Insurance , Electronica , Electro
Common Mistakes in Anesthesia Coding
2007-03-02 03:38:00 The most common mistakes in anesthesia coding are the following:Not billing lines under the appropriate provider of serviceNot documenting lines properlyNot billing for cancelled casesAnesthesia medical direction modifiers not supported in documentationMissing 5th digit on ICD-9Missing MAC modifiers and supporting diagnosisNot supporting physical status modifiers with additional diagnosis codingBlog Directories: More About: Take , Coding , Common , Mist , Nest
Illinois Locality 16 Fees downloadable file issue
2007-03-01 01:15:00 During the dates of February 12 - February 20th of 2007 if you downloaded Medicare of Illinois Local ty 16 fees please reivew this alert -ALERTWPS Medicare inadvertently posted the incorrect fees for Illinois Locality 16 affecting the downloadable file version only on 02/12/07. We posted the correct fees to the Website on 02/20/07.MOST PROVIDERS NOT AFFECTEDIf you sent in claims for Illinois Locality 16 for 2007 dates of service, AND you only billed the allowed amount based upon the fee schedule allowed amounts, AND you used the fees from the version of the downloadable file for Illinois Locality 16 posted between 02/12/07 - 02/20/07, you may be affected.Please note this DOES NOT AFFECT YOU IF:• You did not download IL locality 16 fees from our Website between February 12-20, 2007• You used the "Download All States" feature• You used the viewable PDF for Illinois Locality 16• You used the downloadable Illinois Locality 16 feature previous to or after February 12-20, 2007If yo... More About: File , Fees
LT (Left) and RT (Right) Modifiers
2007-02-28 01:35:00 A medical biller will use these modifiers to identify when a procedure was performed on both the Left and Right side of the body.When billing insurance carriers you will run into times where the provider treated both sides of the body and will indicate the procedure two times. If you bill your insurance carrier without the proper modifiers one of the line items will be denied as a duplicate.In this case you will attach the RT modifier to one of the procedure codes and the LT modifier to the other procedure code.An Example of when to use Left and Right modifiers:A patient is referred to an imaging center for carpal tunnel on both wrists. The technician indicates they performed procedure code 73100 LT and a 73100 RT. Blog Directories: p> Blog Directory Telehealth: doctors diagnosing patients over the web? , More About: Modi , Modifier
Procedure 92065 Orthoptic/Pleoptic Training
2007-02-27 05:20:00 When using procedure code 92065 Orthoptic and/or Pleoptic training, with continuing medical direction and evaluation you can bill as:9206592065 TC (technical component)92065 26 (professional component - certain procedures are a combination of a physician component and a technical component. When the physician component is reported seperately, the service may be identified by adding modifier 26 to the usual procedure number)Terminology identifies this procedure as including services for both eyes meaning this code is unilateral OR bilateral. You will not need to use modifier 50.You will not use RT or LF modifiers and you won't want to bill using two units.Suggestion: if you receive a denial "reject incorrect # of units billed" you will want to edit your claim and rebill . Usually you can do this with just a few clicks and submit electronic claims whenever you can for quicker turn around on your insurance payments. More About: Training , Rain , Train , Proc , Opti
How to identify a New Patient when billing an E/M Evaluation & Manageme
2007-02-27 02:55:00 Classification of Evaluation and Mana gement (E/M) ServicesWhen reviewing E&M services they are split up into broad categories like office visits, hospital visits and consultations. Most of the categories are further divided into two or more subcategories of Evaluation and Management services.First identify if the patient is a new patient by asking yourself the following questions:1. Has your provider ever treated this patient before?2. Has any of the other providers within the same specialty who belongs to the same group practice ever treated this patient within the last 3 years?If you answered No to both of these your patient is a New patient.An established patient is one who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three yearsIf the doctor has another provider “on call” for him, the patient’s encounter will be classified as if the patient had been treated by hi... More About: How To , Billing
GA Modifiers - When to use
2007-02-21 04:37:00 Medical billing and modifiers go hand in hand. As a medical biller you will need to know when to use a modifier in order to get paid out and sometimes it may feel like some crazy game that no one really understands the rules of. But play we must and so here is my take on the GA modifier.When to use a GA Modi fier? - When you feel the item or service will be denied as not reasonable and necessary and a Advanced Beneficiary Notice (ABN) was given to the beneficiary for signature.- When you feel you will receive so-called “Medical Necessity” denials- The GA Modifier also may be used with assigned and unassigned claims for DMEPO’s where one of the following Part B “technical denials” may applyo Prohibited telephone solicitationo No supplier numbero Failure to obtain an advance determination of coverageYou are required to attach the GA modifier anytime you obtain a signed ABN form and you furnish services. Example: A patient with Medicare primary benefits visits her chiropractor...
Billing Medicare Secondary Payor or MSP claims
2007-02-18 03:46:00 If your office bills to Medicare a lot you may have run into a situation when a patient calls you and says that Medicare is requesting them to fill out a SCD form. SCD means Second ary Claim Development and it's a questionnaire form Medicare requires the patient to fill out prior to processing YOUR claim.When or if Medicare receives a claim from the medical office with a primary EOB attached it "flags" them to request this information from the patient if this form is not on file at Medicare.The issue for the medical billing office is now the claim is on a hold status until Medicare receives the SCD form back from the patient (NO MONEY). To resolve this issue train the front office to have a Medicare Secondary Payor (MSP)form on file and have the patient fill it out prior to treatment. This is only necessary if a patient presents with a second medical insurance card.Have the front office scan this form into the patients chart files in the medical billing software you use so you will ... More About: Care , Billing , Claims
Medical Billers be aware: Medicare will not pay Chiropractors if Modifier A
2007-02-03 03:36:00 Medical Billing for Chiropractic services seems easy enough. So, it came as a surprise to me when a medical billing service I consult for called me:Jennifer, we are about to lose our new chiropractic provider because we can’t seem to get Medicare to pay out on his claims. We have called Medicare but they won’t help us with coding questions.My question to them was, “Are you billing with Modifiers?” The response was a panicked, “Do we need to?”YES!If you are not familiar to medical billing for chiropractors let’s go over Medicare’s medical billing guidelines.Chiropractors can bill the following procedure codes:98940 Chiropractic Manipulation Treatment (CMT); Spinal, one or two regions98941 Spinal 3-4 regions98942, Spinal 5 regionsSo, I know what you are thinking; what if the patient is treated for carpal tunnel, or knees popping can we bill for that? No, if the chiropractor treats anything outside of the spinal regions Medicare will not pay out on the claim.Now the mod... More About: Medical , War , Ware , Actors , Care
Telehealth: doctors diagnosing patients over the web?
More articles from this author:2007-01-30 04:32:00 Recently, one of the doctors I billed for "Dr. Bob," asked me if he could bill for Tele health Services - fancy term for a doctor to diagnose patients via a web cam."Dr. Bob" is a psychiatrist who works in a hospital, nursing home and main office setting. He loves using the latest techy gadets (more of a bragging contest with the other doctors), and he saw the Telehealth program as being the new technological "Big Thing" he could boast about. After further review we identified that we were needed to find a Rural Facility to partner with (visit http://bhpr.hrsa.gov/shortage/). We could then begin scheduling and treating patients via videoconferencing software.For more information for your provider visit Medicare's Website:Steps to view Medicares Telehealth documentation1. Click on http://www.cms.hhs.gov/2. Click on Regulations and Guidance3. Click on Manuals4. Click on Internet Only Manuals (IOM's)5. Scroll down under Publication and click on #100-046. Click on Chapter 12 Physician/... More About: Health , Doctors , The Web , Patients 1, 2, 3 |
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