billing

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    Wiki NP DNP

    Hello my fellow AAPC members. I am looking for advice. I have a provider who is a NP DNP and started her own practice in NY. She has worked as an NP under another practice for years treating patients under an MD. She hasn't been with him for over a year now. Her specialty is pain management...
  2. M

    Wiki TRIBAL FQHC

    I work for a Tribal FQHC and have some questions regarding procedures not associated with a G code under FQHC guidelines. It has been our directive to split out the procedure codes (for example I&D, wart removal, etc) and submit those to Medicare B. However, when I am researching FQHC...
  3. S

    Wiki Reporting sample drugs

    Hello does anyone report the administration of free sample drugs to the payer with a zero dollar charge along with the administration and an e/m if applicable? thank you in advance. To me it would appear audit worthy to see just the e/m and the administration without a drug of some sort. Jeffrey
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    Wiki CPT 33285

    Can someone please offer some knowledge on this cpt code. 33285. (This is for Professional claims) NY state(NYC) We have been billing Empire BCBS( Mainly mediblue) for this service both inpatient and outpatient. Under BCBS policy the dx that we have been billing Z86.73 or R55 are allowed per...
    • PatriciaR
    • Thread
    • bcbs bcbs denials billing cardiology
    • Replies: 1
    • Forum: Cardiology
  5. C

    Wiki ILR (implantable loop recorder)

    Can someone please tell me if they have located DX for ILR specifically CPT 33285 or 33286 with in LCD or MCD TIA
  6. S

    Wiki Commercial and Medicaid Maternity Billing

    Hello, We often have patients that have commercial insurance with Medicaid primary for all of their maternity care. If the patient meets the requirements for a global delivery we will bill the global delivery but in this case the patient doesn't have maternity coverage with her commercial...
    • Sarita85
    • Thread
    • billing coding maternity obcoding obgyn obstetrical prenatal
    • Replies: 2
    • Forum: OB/GYN
  7. H

    Wiki Locus and telemedicine

    Does anyone have any experience or knowledge on using off site locums tenens provider to bill telemedicine and what requirements I might need to follow or make sure are enforced? Is an offsite locums different than onsite?
  8. K

    Wiki Starting A Billing Company

    Hello! I was wondering if anyone had any experience starting their own billing company that could give me any advice? I have already completed all legal components (with the exception of the errors and omissions insurance, I am still shopping around for that). Does anyone have any experience...
  9. K

    Wiki Billing for a PA in a Teaching University

    Hello Folks, Does anybody have any knowledge/experience doing this? One of my clients ( a PA ) has just joined the University Hospital. The Billing Department is not sure how to bill for her services. Any help/advise would help. Thx a lot Ken Lobo
  10. S

    Wiki Kareo vs NueMD

    Hello! I work for a small endocrinology practice and we are currently using Practice Fusion as our EMR and NueMD as our PM system. I am currently looking to change our PM system from NueMD to Kareo. Kareo seems pretty great from what I can tell, but I am not totally sold on the idea yet. I was...
  11. M

    Wiki Billing for RN services with no supervising provider in the office

    I work in an outpatient medical and mental health clinic with 2 locations. My location is mainly admin staff and social workers. We do have an ANP and an RN at this location, but the ANP is moving his office to our other location. The problem is that the nurse wants to remain here and continue...
  12. K

    Wiki Tobacco counseling billing

    UHC has new issue. They stated that tobacco use counseling covered under optim dx and recommended claim submission to rx. Does anyone already bill 99406 to rx? Thank you
  13. R

    Wiki Pacer billing help w/26 & TC mods

    I'm still new to coding and I haven't dealt with pacers before. Our NP does the interrogation then Doc reads the report. Am I supposed to be billing 93288 with 26 under and TC under doc? To me, that is exactly what I should be doing but NP has "built pacer clinic from ground up" and believes...
  14. K

    Wiki billing L&I

    I really need some help. The urgent care clinic that I work for uses a national billing company. This company is billing all of our new L&I claims as new patients even if they are established patients with us. When I objected they took it to the person who is the head of their entire billing...
  15. J

    Wiki Co-96

    Hi, We have a few claims who denied payment because of reason code CO-96 (Non covered charges ) from Primary as well as Secondary insurance. Can we bill this to patient? Please advise. Jay
  16. E

    Wiki Modifier 55 NIGHTMARE

    Can anyone please tell me how to get a claim paid when using modifier 55? We had a patient who came in as post operative management care after having ORIF on tibia out of state. According to Medicare guidelines you are to bill the procedure using date of procedure with modifier 55 and place of...
  17. E

    Wiki Billing Add On Codes on One Claim that Span Multiple Dates of Services

    Hello, I am a new medical coder and biller, and I am trying to understand if primary codes and add on codes must be billed on the same day when there is a span of dates of services on one claim. Please help. Thank you, Hilliard Emmanuel McDonald
  18. E

    Wiki Denial from Primary

    If a patient has two insurances and the primary denies (denial is appealed and upheld), do you have to bill the secondary insurance? A co-worker was told to adjust and to not bill the secondary at all.
  19. A

    Wiki Should I wait until the pt is discharged from hospital to create and send the claim?

    Hello everyone, I need your help... I am working in a practice that have been doing the hospital billing the same way for the last couple of decades. They are very fortunate to have the same employee for almost 40 years. Now that I involved in the hospital billing I have been informed that they...
  20. J

    Wiki billing for delivery DR didn't attend?

    I am at an FQHC Indian Health Facility for general family practice. One of my new providers who will be providing OB care is wanting me to bill for a delivery that she was not present for. I have never done OB coding or billing before but it seems wrong to me. Apparently she is part of a group...
    • jesicat
    • Thread
    • billing fqhc obcoding
    • Replies: 1
    • Forum: OB/GYN
  21. A

    Wiki Supervising Physician Requirements with Regards to Billing

    Hello, I am new to the billing/coding world. I've been coding and billing for workers compensation and have some questions. I work for an urgent care in CA with 1 supervising physician and many NP/PA/Locum providers. When billing, the 1500 has the supervising physicians name/NPI in box 17. He...
  22. M

    Wiki Icd 10 to cpt cross walk

    What is the best tool to cross a codes CPT's by ICD 10? For example, If I would like to see what procedures can be performed for a condition such as (A63.0)? What is the best tool out there which everyone uses? I appreciate your help.
  23. L

    Wiki non-credentials NPs billing under credentialed NPs

    Are there any other organizations billing one NP's service under another NP's name and NPI? We have new mid-level providers who aren't yet credentialed, so the established mid-level providers in the clinic are signing the notes and expecting the claims to go out under their name and NPI...
  24. C

    Wiki Cpc_a resume for remote coding position

    Courtney Beth Gainey (Burk) CPC-A 1400 Margina Ave Daytona Beach, FL 32114 Phone: (678)654-7644 E-mail: courtneybethgainey@msn.com PROFILE: Highly capable and detail-oriented professional seeking a Medical Coding position to utilize and enhance industry knowledge and coding education...
  25. S

    Wiki Bilateral Procedures for ASC

    Can someone please clarify how to bill bilateral procedures for ASC (Ambulatory Surgery Center)? I've heard that it varies between payers, but I just someone just told me that Medicare will not accept modifier -50 for ASC and that we have to bill -LT/-RT on separate line items. Is this correct...
  26. T

    Wiki Pathology Coding

    Hi fellow CODERS! I hope this message finds you well. I am in need of some clarification around lab billing. I am not very familiar and would like to get some feedback. our office is billing multiple CPT codes in the Microbiome area. One being 87798, as we know this is an unlisted code...
  27. N

    Wiki Celerity

    Does anyone out there use Celerity for their EHR & billing? Also is there anyone that uses it for residential services and office visit professional services? What are your thoughts? Any helpful hints? What issues do you have? What clearinghouse do you use with Celerity?
  28. K

    Wiki Billing TCM & G0506 Together

    Hello, Looking for some feedback on billing TCM and CCM code G0506 together. It's been brought to our attention that these are denying when billed together. Wondering if a simple -25 modifier would fix or if this isn't allowed. Can't seem to find any clear documentation in the guidelines. Thanks!
  29. S

    Wiki Biller/Coder w/ ASC/SDS Expertise - Looking For FT Work (Remote or NW Houston, TX)

    Hello, I am a certified Medical Biller and Coder with expertise in multi-specialty Ambulatory Surgery Centers/Same Day Surgery looking for full time work either remotely or in Northwest Houston, TX. Willing to do Billing, Coding, or Both. Attached is my resume for your review.
  30. K

    Wiki seeing patients without ID

    Where I work we are allowed to check in patients without picture id providing they are cash pay. It concerns me that we are creating medical records and writing prescriptions for these patients. Do I have reason to be concerned or should I just relax?
  31. K

    Wiki Carc pr-275

    I have a patient with Providence as primary and BxBs as a secondary payor and the first bxbs payment came through just fine, the patient had some copay, some deductible, and some write off. 2 months later BxBs sent me another EOB saying all of the write off amount has been changed to patient...
  32. J

    Wiki Flu Shot by Pharmacist

    When a flu shot is given by a pharmacist, how does that get billed? Can the administration be billed? And would it be submitted under the pharmacist or does a provider need to sign off on it? I am new to flu shots being given by a pharmacist versus given in a clinic by a nurse.
  33. U

    Wiki Hands on learner, looking for help.

    Good afternoon everyone, I recently graduated from Penn Foster Medical Billing and Coding program and was wondering if their is any hands resources available. I want to start practicing to get certified, but I am more of a hands on learner when it comes to things. I currently work as an...
  34. H

    Wiki Physician, Coder Issues

    I am wondering if any one knows where to find a document that you can have your physicians sign, stating that they are liable for any billing issues, such as fraud etc. I was told at a Medicaid conference you can have your physicians sign one. I only want one because I am told alot to just bill...
  35. K

    Wiki Can PAs and NPs see a NEW Medicare Patient?

    Hi there, I work in a Dermatology practice and there has been some discussion over billing for PAs and NPs... I'm wondering: Can PAs and NPs see NEW Medicare Patients? Thanks!!
  36. L

    Wiki Revenue cycle management

    I am a experienced Revenue Cycle Specialist and I am looking for a remote position in Revenue Cycle Management. Skills: AR, Billing, Payment Posting, Authorizations, Medical Audit Review and Recovery and Refunds
  37. U

    Wiki 2 billing companies for the same medical group

    Hi, A medical group in LA wants to try a second billing company for Medicare claims, Noridian as MAC and for CCM (chronic care management) related claims only. For the rest of their billing, they want to keep their current biller. What is the exact process that the group, the current biller...
  38. D

    Wiki NP seeing patients without physician on site

    Can a nurse practitioner see patients in a family practice office where the collaborating physician does not see patients and is not on site ever? Can the NP bill under the physician's name for those plans that do not recognize NPs? This is in the state of Florida.
  39. O

    Wiki NP in Credentialing Process

    Can anyone give me some advice on if we are in compliance by allowing our NP who is in the process of being credentialed(apps already submitted) to see the patients on her own without the provider going in the rooms with her but who is readily available to answer any questions she may have...
  40. E

    Wiki Fracture care help

    Could really use some help, My provider saw a new patient for a fracture of distal radius, nondisplaced. She origionally went to an urgent care center and was told she had a fracture and to follow up with ortho. The impression of the office note states "patient was given a brace, follow up in 2...
  41. A

    Wiki 99090 Analysis of clinical stored data

    Does anyone bill this for reviewing a massive chart before seeing the patient, and if you do, does it get paid? Also what do you bill for it? Thanks in advance!
  42. S

    Wiki Over Coding Issue

    Hi Everyone, I've recently started a new position with a family planning clinic and I'm the first coder they've ever had. The previous billing supervisor, who is no longer with the company, put a rule in place that all procedures should be billed with an E/M code & modifier 25. As we all know...
  43. B

    Wiki Patient's Refusal to Pay Cost-Share

    Looking for some guidance. In my 7 years in this practice, I have never had a patient refuse to pay an invoice. We've never had to use a collection agency. Patient was billed timely for cost-share of $330. Patient's response to my invoice is that copays should be $12 per visit and not $30. My...
  44. C

    Wiki New provider not credentialed with health plans

    Hi there, We have a new provider (an MD - not an NP) who is not quite credentialed with all the health plans our practice participates with. When she sees patients who have an insurance she is not credentialed with, I have been directed to bill those claims under another physician at the...
  45. A

    Wiki Routine Eye Exam vs. Medical

    If a patient comes in for a routine eye exam but the provider finds a medical diagnosis, as a coder I am trying to find backup that shows that unless we treat the patient for said medical diagnosis, we must bill to the vision insurance. Example: Patient comes in for yearly routine visit and...
  46. C

    Wiki Cpc-a iso remote medical coding position

    COURTNEY GAINEY CPC-A courtneybethgainey@msn.com 678-654-7644
  47. T

    Wiki Billing office structure

    Hello! I am looking for examples of current billing office structures. How many staff you have and what their job descriptions are? Do you have your accounts divided up by last name, payor or by account activities? Any information would be helpful! Thank you! Tara
  48. O

    Wiki Drug Screen Billing

    Was wondering if we have pts sign a Drug Screen Attestation are we allowed to bill them Medicare Rates when their insurance denies as excessive.
  49. L

    Wiki Gadavist

    Can you bill for Gadavist (contrast) from both a 10ml AND 7.5 ml vial? The radiologist used 175 units of Gadavist, a whole 10ml vial, and 10 units from a 7.5ml vial, leaving 65 units of waste In our system, the NDC and pricing is tied to the 10ml vial. How would one bill for this?
  50. O

    Wiki New Patient Visits

    I am a biller with a group in Tennessee, currently we have a system when a midlevel (NP) goes in and takes and documents the new pt encounter visit, goes out presents the case to the MD. He then goes in and finalizes the encounter and the plan w/ the new pt and we bill "incident-to" new pt visit...
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