billing

  1. E

    Wiki Incident-To Billing - new symptom/condition ???

    Can someone tell me whether or not an acute illness, like sinus infection, ear infection, etc., is considered a "new problem" and if an APP/NP can diagnose/treat patient if billing incident to. I just feel like something so simple shouldn't be considered "new condition" that the MD/DO hasn't...
  2. M

    Wiki Multiple Hospitalists Same Day Consult, Sub-Specialty. Can We Bill Both?

    Hi! We need some help! One of our hospitalists wants to be able to consult for our hospitalist group when he’s not in our state, for infectious disease, which is his subspecialty. He wants to bill telehealth under our group TIN/NPI. Can a hospitalist consult (via telehealth) for another...
    • mmfaust
    • Thread
    • billing hospitalist same day telehealth telehealth across state lines
    • Replies: 0
    • Forum: General Discussion
  3. E

    Wiki National vs Adjustment?

    Currently working on our fee schedule and I'm confused as to what fee to look at...national or adjusted? I have my setting to Michigan so is that the adjusted column - Michigan fees? Thank you!
  4. J

    Wiki Reimbursement rate for modifiers U7 and SA

    Hello! I was curious - for dermatology outpatient, does the use of modifiers U7 or SA affect reimbursement rate at all?
  5. ahrx13

    Wiki Termination of insurance appeal

    We've been getting multiple claim denials lately stating that the member's coverage was terminated, usually just a few days before the date of service. We go online to confirm their active status and call for benefits before or on the date of service. We try to appeal the claim and state that...
  6. bekka

    Wiki Medicare billing dental

    Is anyone billing the new accepted dental codes to Medicare with success on more than one line item? For example we billed a D7210- 4 times each separate line and they are paying one and denying the others as duplicates? Any one have any suggestions. No matter the code they are only paying one...
  7. E

    Wiki E66.01 Criteria

    Hello! I have a question/concern regarding E66.01 listed on some of our patients HCC lists that our ACO gives us for our Medicare Advantage patients. This code is sometimes listed for patients with comorbidities but their BMI is less than 35 - I have always been under the impression that E66.01...
    • eharloff
    • Thread
    • billing coding e66.01 hcc morbid obesity
    • Replies: 3
    • Forum: ICD-10
  8. J

    Wiki NJ/NY Providers billing issues (tax ID registered in NJ provider in NY)

    The practice I work for recently brought on a pain management MD who sees patients in NY. we have been having issues with BCBS specifically the out of state plans stating since the MD sees patients outside of NJ it needs to be submitted to the New York local and not our NJ local. Does anyone...
  9. L

    Wiki Employee write off - bill ins?

    Hello, We are having a discussion at work regarding writing off an employees balance. Some are saying it's okay to bill insurance and just write off any patient(employee) responsibility. That way the office at least gets some compensation. The coder lead saying that it's not okay and that we...
  10. E

    Wiki Adjustment Reason Code 107

    I am so confused on what this ARC means. This was sent back to me by Blue Care Network (part of BCBS of MI)... I billed a TCM (99496) and Medication Reconciliation (1111F). The claim was processed without payment due the following: CO-107: The related or qualifying claim/service was not...
  11. J

    Wiki JW Medication waste billing

    Has anyone come up with an efficient strategy to deal with reporting RX waste charges, when a vial size is used that leaves waste beyond the optimal vial size combination? "The units billed should where possible correspond with the smallest dose (vial) available for purchase from the...
  12. C

    Wiki Billing Questions Highmark Speech Therapy Claims Denials

    So this is more billing related rather than coding related... But I am at a loss and figured it would not hurt to ask. I work for large FQHC as a Coding and Billing specialist. We bill for Speech and Occupational Therapy.. These kid's are seen multiple times a week and usually exhaust their...
  13. P

    Wiki What is the scope of practice for a LCSW?

    Can a LCSW bill for the following services? 99457/99458 99449 99424/99425 99441-99443
  14. B

    Wiki Office visit & injection on same date of service

    I just started working for a small practice and I'm seeing that when a patient comes in for a hormone pellet injection and office visit on the same date of service, they have been billing insurance for the office visit and having the patient pay cash for the pellets and not billing insurance for...
  15. C

    Wiki Pennsylvania Medicaid Audio-Only Telehealth Denials

    I'm in need of some help here with audio-only telehealth claims for Medicare patients with secondary Pennsylvania Medicaid plans. When billing Medicare (as primary), we use codes 99441-99443. However, we run into a problem with the claim going to secondary. PA Medicaid only accepts G2012 for...
    • caitlin1994
    • Thread
    • audio only audio-only audio-only telehealth billing medicaid medicaid pennsylvania medical billing medical coding pennsylvania telehealth
    • Replies: 0
    • Forum: Billing/Reimbursement
  16. F

    Wiki CPC-A Earned December 2023

    I am a highly motivated and detail-oriented individual with a strong passion for Medical Coding and Billing. I completed the Outpatient Medical Coding and Billing program at CareerStep.com in November 2023 allowing me to earn my CPC-A in December 2023. I gained a comprehensive knowledge and...
  17. M

    Wiki Covering Physician

    How can we ensure that our practice bills appropriately for a new provider who is not yet fully credentialed? Can we still bill with Mod Q6 even though the provider is still in the credentialing process and is most likely joining the practice?
  18. S

    Wiki JCode for Fluorouracil

    Is anyone familiar with a jcode for Fluorouracil USP 2.5mg? I'm only finding one for 500mg.
  19. A

    Wiki Difference between Independent Clinic (POS 49) vs Office place of service (POS 11)

    Can someone help me in explaining what is the difference between independent clinic (POS 49) and Office ( POS 11) as well as the scope of practice and types of services offered in both?
  20. M

    Wiki incident-to drug screens question

    One of our providers only works remotely and sees all his patients through telehealth. He sees patients who are going through treatment for opioid addiction. This requires the patients to come into the clinic and have drug screens performed by the medical assistant. Since this provider is never...
  21. P

    Wiki Medication Billing: Misoprostol

    Hello, our patient took Misoprostol but had to spit right away due to anterior placenta. Is this considered administered and billed as is? Or do we bill the medication as discarded drug with modifier -JW? Thanks for all your help
  22. B

    Wiki Psychotherapy via Telehealth While on Vacation

    Hi there, and thank you all in advance! I have a behavioral health provider (LPC) who has an opportunity to work remotely in another country for a few months and was hoping to continue to see their patients via telehealth while away. The provider is licensed in the state all of their patients...
  23. T

    Wiki Humana denial- Looking for guidance.

    I'm confused about forwarding billing onto patients with Humana. My practice is asking that I forward non-covered services to the patient when they are denied by humana plan. Since it is a Medicare replacement, can I do that? I thought it had to be written off because it is denied by insurance...
  24. A

    Wiki Patient With Medicaid in 2 States - Who would you bill?

    I have occasionally come across patients who, somehow & some way, have active Medicaid in two states. For example, they have active Medicaid in Arizona while being active with Medi-Cal at the same time. I've also seen one state have a COB with another state (ex. Nevada Medicaid shows that...
  25. B

    Wiki Remote Anesthesia Coding

    Remote Workers: I'm coding and posting charges remotely based off anesthesia records. Demographics are already in the client's system. For those who are engaged in this type of work, what is your compensation (per charge posting) for this type of work? TIA
  26. B

    Wiki Out of Network Provider Different Charges

    99% sure I know the answer but I'd love to confirm A provider cannot charge different rates for the same service based on what the insurer allows, correct? And this applies to both in and out of network providers, yes? As an out of network provider doesn't have a contract with the insurer I...
  27. T

    Wiki Florida Medicaid Crossover Claims Issues

    Hi, all! I am new to billing in the state of Florida (and was totally thrown into this position unexpectedly due to several people walking out), and I am having an issue keying Florida Medicaid secondary claims into the FMMIS portal when the Primary payer is a Medicare Advantage plan. As I...
  28. kdabis808

    Wiki CHIROPRACTOR THERAPY BILLING: 98940 & 97140-59 (2 UNITS)

    Hello, I recently started billing for a new chiropractor therapy practice. I also do billing for another chiro; he bills 98940 & 97140-59 and gets paid just fine by this one payor. But the new chiro, bills 98940 and 97140-59 (2 units --30 mins thats why); and her's gets rejected as bundling...
  29. M

    Wiki Office visit + preventative counseling for MEDICARE patient

    Hello, I do medical billing for a "weight management" doctor (AKA a primary care physician whose niche is providing weight loss medicines and counseling). As some of you may know, Medicare does not accept the typical weight prevention counseling codes other commercial carriers accept...
  30. N

    Wiki CPT Code 99211 - E&M Office

    For Covid19 testing, 99211 was authorized to be billed as a specimen collection code. Can 99211 also be billed as a STI (Sexually transmitted infections (STIs) collection code? What does CPT code 99211 mean? CPT defines this code as an “office or other outpatient visit for the evaluation and...
  31. T

    Wiki Aetna Medicare: Zilretta Policy

    Hi all, I'm inquiring about the Aetna Medicare Zilretta Injection Policy. Does a patient have to wait 3 or 6 months between Zilretta (J3304) Injections? I cannot find that information anywhere! Thanks!
  32. JWash618

    Wiki ABA billing with no Auth (cross posted)

    Is it standard practice to start billing ABA services to insurance companies before an authorization is issued? I thought that billing was not supposed to be done before an authorization was given, but I have been told to bill anyway, sometimes for several months before an authorization comes...
  33. JWash618

    Wiki ABA Billing without a Pre-Auth

    Is it standard practice to start billing ABA services to insurance companies before an authorization is issued? I thought that billing was not supposed to be done before an authorization was given, but I have been told to bill anyway, sometimes for several months before an authorization comes...
  34. B

    Wiki Medicaid as Secondary Contractual Obligation Write off

    I have a patient with commercial insurance as primary, Medicaid as secondary. I'm not sure that their claims paid out properly. We charged $185 for a service - the primary payer determined they owed $85, the patient owed $25 copay, and the contractual write-off was $75 We sent in a secondary...
  35. M

    Wiki Billing in ALF's

    Can anyone help with billing codes for psych services provided by a Nurse practitioner in the assisted living facilities?
  36. M

    Wiki No Surprises Act good faith estimate for walk-ins

    From what I understand, as an FQHC we have to provide our self pay patients an estimate at least one day before their service, but we often get walk-ins and same day appointments. How are we supposed to abide by this law when we have patients coming in the same day the appointment is scheduled...
  37. M

    Wiki Documentation requirements for billing remote patient monitoring?

    Hi all, I'm new to reimbursement regarding remote patient monitoring (CPT codes: 99453, 99454, 99457, 00458 and 99091). What documentation from the patient record are payers wanting to be included with claim? TIA
    • Mrsrpc
    • Thread
    • billing claims submission remote patient monitoring supporting documentation
    • Replies: 3
    • Forum: Billing/Reimbursement
  38. M

    Wiki CPT CODE QUESTION

    Hi, Our office just added a vascular lab, there are two CPT codes 75726 & 75744 that we are trying to find out if they are globaled or require a modifier when billed with the CPT codes below: 37220 37221 37222 37223 37224 37225 37226 37227 37228 37229 37252 37253 76937 75726 75716 75774
  39. D

    Wiki Billing Secondary commercial payers

    Hi everyone :) Wondering if anyone could help answer my question in Billing the secondary commercial plan. Just an FYI- Primary is also commercial. Which amounts do we bill the secondary plan? The all amounts that the primary did not cover including denied procedures? Only patient...
  40. J

    Wiki NMD billing as MD

    Hello! I have a quick question: Our practice is intending on bringing an NMD (Naturopathic Doctor) into the practice and have them see patients as their service provider, but have the billing provider listed as an MD. [It's basically two doctors seeing a patient in one visit, with the NMD...
    • jenmendoza
    • Thread
    • billing dermatology insurances naturopathic nmd
    • Replies: 5
    • Forum: Dermatology
  41. M

    Wiki New to FQHC billing

    Our outpatient medical clinic recently became a FQHC. I have been tasked with figuring out what this means for our billing practices, but I have no idea where to begin because this is something I know nothing about. We have been using the CMS 1500 forms for years, but is there a specific form...
  42. M

    Wiki Billing for urgent care facility - any advice?

    Hello, I will be billing for a new urgent care facility in the next month so I wanted to see if anyone has any advice or tips on things to watch out for or look into before we get up and running? We have done some research on billing global packages vs billing as a provider's office, S0988 vs...
  43. D

    Wiki G0180 and POS 32

    Does anyone have a link on why Medicare of NC is denying G0180 with POS 32? They will pay with POS 31.. I'm so confused and can't get help from a rep. Thank you!!!!
  44. A

    Wiki 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...
    • alwilder
    • Thread
    • bbp labs billing insurance source patient source patient labs workers compensation
    • Replies: 1
    • Forum: Billing/Reimbursement
  45. M

    Wiki Nephrology Billing documentation

    My office billers and NP are in a discussion about dialysis unit monthly rounding documentation for billing. We currently use a rounding sheet that has the 3 monthly NP limited visits on one sheet. My NP asked why we could not use the dialysis flow sheet that she reviews makes notes and signs...
  46. B

    Wiki Medicaid Denials

    Hello! I keep getting Medicaid denials for claims and the reason is that it says "Missing Billing Provider Taxonomy number". Well this denial just started happening after years of no issues before, also the billing provider and provider taxonomy numbers are the same, anyone else have this issue...
  47. C

    Wiki Billing Patients Less Than Allowable Amount?

    Are we allowed to bill a patient less than what an insurance company allows? We have a few patients in which a Medicare Advantage insurance has allowed more than they should, and dropped the full allowable amount to the patient, which happens to be their full copayment for an ASC. We have tried...
  48. I

    Wiki Rotor Study

    My provider is doing a "Rotor Study" (injecting contrast- flouro into the spinal pump to make sure its working properly). I have looked everywhere and still cant find an specific code that would best describe this procedure. Does anyone know if there is a code for this? if not, would the 64999...
    • isa709@yahoo.com
    • Thread
    • billing contrast infusion pump interthecal pump pain management rotor study spinal coding study unlisted code
    • Replies: 0
    • Forum: Billing/Reimbursement
  49. 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
  50. C

    Wiki All EMGs with NCS for bilateral extremities billing question

    Our new Pain Management provider has just yesterday informed me that he and his staff have always been billing them like this: "Bilateral Upper Extremities: 95911 for 9-10 studies 95886 95886, 76 modifier Bilateral Lower Extremities: 95910 for 7-8 studies 95886 95886, 76 modifiers The lower...
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