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HIPAA / Re: HIPAA Compliant Email Service?
« Last post by Shawn on March 14, 2018, 09:55:48 PM »
Michele, you wrote a few years ago, "we are currently using yousendit    We haven't used them long, we just started with them.  Not sure yet how we feel."
Are you still using the same service? I looked them up and don't see anything about HIPAA compliance on their main page.
Billing / Re: Billing under a specific license when dual licensed
« Last post by FHA on March 14, 2018, 10:22:00 AM »
Thank you, that makes sense. Was hoping not to have to contact insurance carriers esp since BCBS of IL and HMA Regence are almost impossible to get ahold of but looks like I have no choice. Thanks again!
Billing / Re: rocephin
« Last post by Michele on March 14, 2018, 07:19:55 AM »
If it is only AARP Medicare Complete and you are not receiving any denials from any other carriers then I would contact AARP Medicare Complete to ask them what changed.  It does not appear to be a national change as I don't see anything out there indicating it is a problem.  It looks like it is carrier specific.  They may have changed something on how they want it reported or it may be a mistake.
Billing / Re: Billing under a specific license when dual licensed
« Last post by Michele on March 14, 2018, 07:13:48 AM »
I believe this is something you need to make sure is on file with the insurance carriers.   On the CMS form you can indicate the credentials by the providers name for the license you are billing for, but the insurance carriers have the providers loaded into their systems under the NPI/Tax ID so I don't know if that will make a difference.
Billing / rocephin
« Last post by stellerdobes on March 14, 2018, 04:31:03 AM »
We are now having trouble with AARP medicare complete paying for Rocephin.  It didn't use to be a problem.  I always billed J0696 time 4 for 1 gram.  Now they are denying saying that  Payer deems the information submitted does not support this dosage.  Any ideas
Billing / Billing under a specific license when dual licensed
« Last post by FHA on March 13, 2018, 10:21:17 PM »
When a provider is credentialed with 2 different licenses, how do we bill in way to signify (somewhere on the HCFA I assume?) that we are billing under a specific license? This is an issue because for a particular service, the reimbursement is different under one license than the other. We would like to change it so the billing defaults to the license that receives higher reimbursement.
Thank you for your time.
Coding / Re: Coding question
« Last post by PMRNC on March 13, 2018, 02:59:48 PM »
Has anyone billed for the following codes and if so can you tell me the documentation and medical necessity to safely bill and approximate reimbursement.

I took this as looking for ways to document medical necessity to which I nor anyone else really can answer. The coding needs to "support" the documentation in the file. The codes provided were services codes to which diagnosis codes are assigned by the provider's documented and signed notes.
Coding / Re: Coding question
« Last post by Michele on March 13, 2018, 12:48:05 PM »
We do bill for a couple of these but honestly most are not covered.  They are billed in addition to an E&M code and most insurances either do not cover or they are inclusive of the E&M (even with a 25 modifier).
Billing / Re: Starting Small Group Practice
« Last post by Michele on March 13, 2018, 12:46:11 PM »
The W9 is the information regarding the EIN/Tax ID.  Since that is the group, the individual's name is not listed on there.  The W9 must be signed by an authorized representative of the group, which in many cases is the owner.
Billing / Re: Invisalign Billing
« Last post by PMRNC on March 13, 2018, 11:13:06 AM »
I did Invisalign from Feb 2016-December 2016. I paid in full before the treatment started in January 2016, less the $2000 that my insurance covers.

In September of 2017 I changed jobs, and consequently changed insurance.

They shouldn't be billing your new insurance for any services since your effective date with your new carrier is 9/2017 and your prior coverage ended.

I would call them back and ask them what they are billing for and most important; WHAT dates of service are they billing. They could be submitting claims to your new carrier for a balance on the acct but they shouldn't be bililng the new carrier at all. I would request they send you an itemized bill showing all payments from yourself and insurance. As for full accounting of charges and payments on your account.
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