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Billing / Re: Medicare | Appealing Claims
« Last post by kristin on June 27, 2018, 07:36:10 PM »
Each MAC has their own forms for doing appeals. Get on the website for your MAC, and research exactly what forms you will need to fill out/what their process is. Be aware that Medicare may only retro the revalidation back to a certain date, so anything before that date will not be paid.
General Questions / Re: Newbie has questions
« Last post by kristin on June 27, 2018, 07:32:57 PM »
Hello, and welcome! This is a great forum, and very informative. I love helping newbies in this field, so feel free to email me at, and I will do your interview and answer any other questions you may have about my experience/time spent as a biller.
General Questions / Newbie has questions
« Last post by Sweethart2021 on June 27, 2018, 06:37:45 PM »
 hello everyone I am brand new to the forum! I am currently studying to get my medical billing and coding certification in Southern Arizona. I would relish the opportunity to ask the veterans some questions about their experience! Also have three short interviews I need to complete in order to secure funding for the remainder of my studies. The interview consists of basic questions like what skills are required, what is the job market like, what is the salary like , Etc. I would so appreciate anyone of you taking a few minutes to share your experience and answer a few questions, either over the phone or through email! Thank you so much and can't wait to become an active member of the coding community!
Billing / Medicare | Appealing Claims
« Last post by avehildebrand on June 27, 2018, 12:10:47 PM »

I work at a Physical Therapy office and one of our PT's validation never got renewed for Medicare and she was the "rendering provider". So all of our claims have been denied due to her no longer being eligible. I went ahead and re submitted the 855i for her to add her back onto our group. Once she is approved I then need to file appeals for all of the outstanding claims that were originally denied.

Does anyone have any experience filing appeals with Medicare? Or any advice that would be helpful once I start that process? I am concerned that they will not pay out for any of these visits.

Thank you! :)
Billing / Re: New To Medicare
« Last post by lacycr on June 27, 2018, 10:47:14 AM »
Thanks Michele! That is helpful. I wanted to clarify one thing. The PT is already enrolled in Medicare. When I looked at the CMS 855R form, it states "both the individual practitioner and the eligible organization/group must be currently enrolled in Medicare program before reassignment can take effect." So I do need to enroll our group (using group NPI?) in Medicare first then do the re-assignemtn for our PT?

If so, since the group will be participating, will all drs then have to be par? or can they still choose to be nonpar? That's the part that confuses me.

Thank you again!
Billing / Re: New To Medicare
« Last post by Michele on June 27, 2018, 10:17:19 AM »
There is no enrollment period for providers, they can enroll anytime.  The enrollment period is for beneficiaries. 

You need to enroll the group as a Provider and then link the PT to the group using a CMS 855R (or through PECOS as a re-assignment).

If the PT is already enrolled in Medicare you only need to do the CMS 855R or re-assignment, if they are not you would need to enroll them as an individual and also do the re-assignment.

I hope that helps!
Coding / Venipunccture
« Last post by Ruthie1972 on June 26, 2018, 05:11:49 PM »
we are setting up phlebotomists for our company with our existing customers,
Some of the tests for example are going to be 00468, 09119, 00443, 0076, 00806.

When we are sending these to Medicaid/Medicare for billing do we also add a venipuncture code?

if there is a special circumstance like finger, scalp, etc will the phlebotomist have to choose an add on code and supply documentation from the APRN?

thank you
Billing / New To Medicare
« Last post by lacycr on June 26, 2018, 05:09:59 PM »
I am working at a medical office and have been doing chiropractic billing for several years. My doctor is non par with medicare and since our demographic is younger athletes and sports medicine, we've never had to do billing for any medicare as again, its not our main demographic.

Now for the part I need help with...we are expanding our services and added a second location as well, we have a new business name/tax id/npi etc. so our new drs we hired are working under that new information. we have hired a physical therapist who IS participating with medicare and wants to see medicare patients. when contacting Noridian, they told me to login into the PECOS system to manage the reassignment and to add our new PT to our office and then once processed we can begin billing for him. However when looking to do that, one of the question is "Is the individual or group who is receiving the applicants benefits enrolled in Medicare?" Is that asking if our organization is enrolled with medicare? If we are not, then can I enroll us mid year like this? I think I remember reading there is an enrollment period. If we enroll the organization, can only that dr be participating and the others be non par? or do they have have to be par?

Sorry if that's confusing! I'm new to medicare and want to make sure I get it set up correctly. Thanks for any help!
Billing / Re: New York Work Comp
« Last post by Michele on June 26, 2018, 12:32:00 PM »
In NY if you do the form you do not need to include office notes.  The form has specific questions that basically includes what would be in the notes.
I would try what Kristin suggested.  The only thing I would add is that if the dr disagrees (which I assume they do) then I would definitely appeal.  I would have the dr do a written explanation as to why they disagree and why they feel the procedures were medically necessary and include any supporting documentation.  It is crucial that the dr is VERY specific and detailed in why they disagree and why it was medically necessary.  Include absolutely any documentation possible to support the drs opinion. 
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