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Facility Billing / Re: Substance Abuse PHP with housing
« Last post by Michele on May 13, 2018, 08:06:24 PM »
What rev code and/or HPCPs code are you billing?  Usually insurances have set fee schedules they pay based on the rev/HCPCs code.
Coding / Re: Billing a PE & a WW on same visit
« Last post by Michele on May 13, 2018, 08:03:42 PM »
Well the problem is that most claims are processed without the notes so just documenting it in the note may not be enough.  Services should be coded with the most accurate diagnosis for that service.  If a gynecological exam is being done then the dx Z01.41 seems to be the most accurate dx code.  But unless you are the coder you will have to go by what the dr says.  If you get denials you can show them that coding with the Z00.00 is causing the well woman to not be covered.
Billing / Re: Toxicology code 80306
« Last post by Michele on May 13, 2018, 07:52:59 PM »
If it is one particular insurance carrier I would contact them and ask them for information on the denial.  Do they have something they can point you too that explains why it is not allowed?  It sounds like it is a specific plan edit.
Billing / Re: Billing Orthotics without DMEPOS #
« Last post by Michele on May 13, 2018, 07:49:51 PM »
Honestly I'm not sure.  I always thought that if you were not a DMERC provider you were not supposed to service Medicare patients.  But if the patient has a secondary that will pay then I'm not sure.  You could try to submit.  The patient must be made aware that you are not a DMERC provider.  A signed ABN should be in their file.
Billing / Re: PT Billing/Modifiers
« Last post by ErickVA65 on May 11, 2018, 08:30:14 AM »
I recommend you to check NCCI on it will help you if it is modifier for both.
General Questions / Re: Welcome Members!
« Last post by Adxenes480 on May 10, 2018, 06:32:19 PM »
I hope to learn more about billing. Im the owner of a facility and I am very frustrated because I know something is not right with our billing and I am trying to learn as much as possible in order to fully be in control of my business.
Facility Billing / Substance Abuse PHP with housing
« Last post by Adxenes480 on May 10, 2018, 06:21:40 PM »
I hope someone can help answer my question. I am billing for PHP services and the facility is licensed as day/night treatment with community housing. Reimbursement from some payers is very low. Are facilities that provide housing, meals, transportation, medication management AND the therapy reimbursed at the same rate as facilities that ONLY provide therapy and the patients live independently?? Weve had claims pay as little as $159 per day. Is there something that we are are doing wrong? Can we bill for room and board?
Coding / Billing/Coding a PE & a WW on same visit
« Last post by lpfamilyphys on May 10, 2018, 11:34:25 AM »
I have a question about billing a Physical Exam and a Well Woman on the same visit.  It is my understanding that if both are done during the same visit the Preventive CPT would/should have both DX codes Z00.00 & Z01.41.  I have one provider that agrees with this billing practice and one that does not.  The provider thinks that Z00.00 should cover both on the CMS 1500 and documenting that a Well Women was done too should be enough in the note.    Any help would be great on this.  Thanks
Billing / Toxicology code 80306
« Last post by cslay901 on May 10, 2018, 10:58:04 AM »

I am receiving denials from insurance company regarding CPT 80306 stating "the procedure code is disallowed based on CPT rules" - But I am receiving payments from other companies using the same code?  - Tried to research it, but couldn't find anything - HELP!!
General Questions / Charge Capture Solutions
« Last post by Billingbilling on May 09, 2018, 05:11:30 PM »
What charge capture softwares have people seen clients using? Particularly those that are at multiple facilities (whether hospitals, or more pertinent for our client, nursing facilities)?
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