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Coding / Re: Sending Dummy CPTs
« Last post by Michele on November 16, 2017, 05:23:35 PM »
It will vary depending on the insurance carrier but my guess is that it will kick out the entire claim.

But I too am curious as to the purpose.
New! / Re: Virtual Mental Health Company Set-Up...Question
« Last post by Michele on November 16, 2017, 05:22:17 PM »
We have offered advice, but not actually helped the owner start up.  Mostly offered help with setting up (credentialing) with insurances and setting up a fee schedule.
Coding / Re: Sending Dummy CPTs
« Last post by PMRNC on November 16, 2017, 04:11:05 PM »
What is the purpose of this?
Coding / Re: Sending Dummy CPTs
« Last post by kristin on November 16, 2017, 04:04:38 PM »
I recently had this happen with a doctor. He insisted I bill certain PQRS codes on his claims, although I knew they would not be accepted by Medicare and some Medicare Advantage plans through Aetna and UHC. Lo and behold, all the claims denied in full because of the PQRS codes. Luckily, I only put about ten through to prove my point to him. So while I cannot answer your question definitively, I can say from my experience that the whole claim denied for one invalid line on each claim.
Insurance Payments / Re: Primary Care
« Last post by kristin on November 16, 2017, 03:58:38 PM »
I have been billing for an Internal Medicine doctor for a few years now, although my specialty is podiatry. IM was super easy to learn, so that is a good thing! I don't have time unfortunately to seriously mentor, but I can tell you a few things if I know more about the kind of practice the doctor will have. Things like:
1. Age range of patients
2. Primarily Medicare/commercial, or will he take Medicaid?
3. Will services beyond office visits will he be providing? Some PCP/IM docs do a lot of services, others are very limited.
New! / Re: E/M charge with laceration repair
« Last post by kristin on November 16, 2017, 03:46:32 PM »
In response to this and your question about E/M and cryotherapy, the simplest thing to do, and this is what I tell doctors/coders:

Audit the treatment note and remove everything relating to the procedure, since an E/M component is already factored into the RVU's for the procedure. Whatever you have left over will determine if you have the elements necessary to bill an E/M. This applies to new and established patients both. If you do have the elements, then determine your level of E/M accordingly, and bill it with a 25 modifier. If you don't have the elements needed, then just bill the procedure performed. As with everything, there are rare exceptions to this...such as if you can use time as an element with the appropriate documentation of time spent face to face with patient and nature of the counseling/coordination of care. Generally though, if the only thing addressed at the time of service is related to the procedure, you will not have a separate, significantly identifiable E/M.

Starting Your Own Medical Billing Business / Re: Phone/Fax Business Services
« Last post by Powerade_993 on November 16, 2017, 02:28:22 PM »
PMRNC - You’re always so helpful! Thank you!!
Coding / Sending Dummy CPTs
« Last post by rcmbilling123 on November 16, 2017, 02:14:17 PM »
Without going into the details, we would like to add made up CPTs to claims. These made up CPTs would all have a $0 charge. To the best of my knowledge, there isn't a modifier that generally excludes a CPT for consideration of a claim. My question is will an insurance company deny the entire claim if we include an invalid CPT? Or will they just deny the one line?
New! / Virtual Mental Health Company Set-Up...Question
« Last post by Jmojica on November 16, 2017, 01:39:32 PM »
Has anyone ever helped a business owner start up a group practice who isn't a practitioner themselves?
Insurance Payments / Primary Care
« Last post by Billingbilling on November 16, 2017, 12:48:01 PM »
Hi everyone,

Thanks for all the helpful replies and information everyone shares on here.

We've done a specialist billing for some time, but am now adding on a primary care/internal medicine outpatient office. Was wondering if there was someone on here with experience in this area who would be willing to provide some mentoring. Going over common pitfalls, best billing/coding practices, areas commonly missed that provide increased revenue opportunity for practice (they physician himself is new to PCP outpatient, and so is looking to us with help in these areas).

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