Medical Billing Forum
General Category => General Questions => : t.cassell February 05, 2018, 05:28:35 PM
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Medicare declined 10061 stating "not medically necessary". The Dr. billed 99347 (housecall) and 11061. Can I resubmit claim for just the house call?
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You really need to determine why the 10061 was denied as not medically necessary. Was it because of the dx code? If only the 10061 was determined to be not medically necessary then they still would have paid the house call. There must be more information on the denial. It's really hard to say without knowing more information. What dx codes were billed? What place of service code was used? Etc.
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Here is an excerpt that may help you get an answer to your question.
When a patient is notified in advance that service or item may be denied as not medically necessary, the provider must annotate this information on the claim (for both paper and electronic claims) by reporting the modifier GA (waiver of liability statement on file).
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Medicare defines it as: “Services or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.” But what we know it to mean is that the insurance company is dragging their feet and simply doesn't want to pay your claims. Another delay tactic, like dropping claims and stating they cannot locate the patient in their systems, and just another way they make their millions in profits.