Medical Billing Forum
Billing => Billing => : CLINTPRIME April 25, 2011, 06:04:39 PM
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Some of our patients receive BID visits (seen twice a day) but if we bill the AM visits first and then 2nd visit another day we get denied payment due to duplicate claim submission. What modifier would I use on a UB-04 & on a HICFA 1500 form for homecare services to indicate to HMO's that the patient is being seen twice a day? Someone help please, thanks.
Clinton
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I don't believe there is a modifier to indicate that. I believe you have to appeal each time. I personally would have a template all set to either attach to the claim, or to use for appeal.
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Thanks for your response. We're a homecare agency in NYC and when we called Health First, their claims department insisted that there is a modifier but of course was unable to specify what or how to show that on the UB04. Thanks
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Maybe Health First has a modifier that they use specific to them??
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Hello, i am currently a home health reimbursement specialist for 15 years, i never have heard such billing practice. Submit your claim with both am and pm visits, episodes are paid per HHRG score. if this claim has more visits than the amount to be paid. The claim will qualify to be paid on a threshold basis, qualifing as an outlier payment (more money, then the actual HHRG score). Snice duplicate claims have been submitted, any subsequent claims will be rejected. Auto cancel any final paid claim, usually ending in 339 or 329, rebill your claim, and follow up for payment pb9997. no modifier in this situation. good luck and great question