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Billing / Re: Medicare Advatage
« Last post by PMRNC on January 19, 2018, 02:32:34 PM »
Quote
It doesn't state anywhere that patients can't go to out of network providers or that the providers have any limit to the charges.

Just because a provider is a Medicare provider, if they are out of network and it's an HMO then the patient would be responsible for charges. If it's just a PPO or POS plan the patient can go to a provider in or out of network and the full fees can be billed. Just keep in mind they may only pay Medicare rates anyway. You can bill normal charges however.
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General Questions / Re: Facility Medicaid Billing
« Last post by mariorodriguez36 on January 19, 2018, 01:08:10 PM »
How do you handle two ER visits within 24 hours? We have a payer that will pay one claim and the other they global our charges. The TMHP manual states "If a client visits the
Emergency Room more than once in one day, the times must be given for each visit.". We've informed the payer that we do this and they still global our claims.

We were wondering if any other facilities have this issue?
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New! / Re: Secondary insurance billing
« Last post by Nancyo2 on January 19, 2018, 12:35:33 PM »
thanks for your replies, happy to have some answers-
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NPI Numbers / NPIs used in integrated office
« Last post by lacycr on January 19, 2018, 11:44:48 AM »
I work for a chiropractor and we are expanding. my chiropractor is opening a new additional location where he is going to hire a an additional chiropractor, a physical therapist and a nurse practitioner to work there as well. The billing will all be done from our first main chiropractic office. when billing for these other providers, we will use their npi for the rendering provider section on a hcfa form but will use my doctors group npi for the billing provider is that correct? we were hoping that all billing could be paid to our main location and then the other providers would be paid a salary. is that the correct way to bill? will there be complications with insurance when they see that a PT provided PT services as a rendering provider but that the services were billed to a chiropractors group NPI?

Second part of the question would be my doctor already has a group/type 2 NPI and obviously a tax ID associated with it. This new location will be under a new corporation and a new business name therefore he will be getting a new tax id for this business. Do we have to get a completely new separate type 2 NPI or can we use his original group NPI since thats where all the billing is being handled?
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Billing / Re: Medicare Advatage
« Last post by Michele on January 19, 2018, 06:50:45 AM »
Each Medicare Advantage Plan has it's own guidelines/rules about out of network providers.  From what I read on CMS they encourage the patients to verify if a provider is in network with their plan and state that their costs will be much less if they use in network providers.  It doesn't state anywhere that patients can't go to out of network providers or that the providers have any limit to the charges.

Anybody else have any information on this?
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Billing / Medicare Advatage
« Last post by Billing2 on January 18, 2018, 01:01:17 PM »
I need help on Medicare Advantage.

Here is what the problem is.  My provider is out of network with the insurances. (Aetna BCBS). So why can't he bill them a full fee for his services?  I've always understood that Medicare advantage follows the same guidelines as Medicare. He is a Medicare provider.

Is that the rule or can we charge the full fee?
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Coding / Re: Preoperative clearance and preoperative Duplex Ultrasound
« Last post by Michele on January 18, 2018, 11:58:17 AM »
I'm not sure how they are billing it.  I would see if they would share what CPT code they use to bill.  Maybe an E&M?

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Coding / Re: new CPT code 36466
« Last post by Michele on January 18, 2018, 11:56:58 AM »
They may not have added that code to their system yet.  I would contact them to see if/when they might do this, or if there is another way it needs to be billed until then.
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General Questions / Re: Facility Medicaid Billing
« Last post by Michele on January 18, 2018, 11:54:54 AM »
Sorry but we haven't had these issues.  We do bill Texas Medicaid HMOs.
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Coding / Re: Preoperative clearance and preoperative Duplex Ultrasound
« Last post by Nancyo2 on January 18, 2018, 11:14:32 AM »
thanks for your reply - the Anesthesiologist performs a preoperative evaluation, in addition to the anesthesia record and recovery room admission. This is also a requirement for our accreditation. The surgeon also performs a preoperative clearance which is included in his surgery fee. We had been advised by other anesthesiologists that they are reimbursed separately for their pre-op workup.
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