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Billing / Re: New York Work Comp
« Last post by stellerdobes on June 26, 2018, 04:23:49 AM »
Thank you for your reply.  So either form but not both.  Do the insurance require the office note in NY?  In Va they will not pay without them. 
Good morning! Hoping I can get assistance with what my next steps should be.

We have a patient we have done the same procedures on 8 times since November.

Before we ever did the procedure, I called multiple times to check to see if authorization was needed. I was told the same thing every time which was all codes are valid and billable no precert required. Two of the codes are covered if medically necessary, notes may be requested to pay claims.

At first, denials were coming in asking for ops notes. They were submitted.

They are Outpatient SX claims. The facility claims are the biggest issue. They are being denied as not covered. but then below that it says, "we have found the service requested is not medically necessary in your case". It then goes on to say "based on current information, coverage cannot be approved because there is insufficient scientific evidence to demonstrate the  safety and/or effectiveness of Amnioband for any indication including wound care....Falls under experimental/investigational/unproven, which the customers plan does not cover."

I need advice on what I can do next. (Appeal, have the doctor discuss with a physician reviewer, send claims to a service like Collect RX). This is a first and I'm confused as to how so many CSRs including the preauth department that these codes were covered and do not require precert and then be denied as not covered. Can someone please help me understand? Thank you in advance and if more information is needed, I will do my best.

There is no way to answer your question in a post.  Too much information!  If you search back on this forum you will find lots of valuable information on starting a business.  You are absolutely right when you state that the hardest part is signing your first client.  Many businesses never make it to that point and give up.  You have to have determination and know that getting clients is the hardest part when you first start.  We do have many resources available on getting started.  We have an ebook available, "How to Start Your Own Successful Medical Billing Business".  You can read more about that at:   We also have several packages available at:

We also have online courses available at:

You might want to consider the online courses because they will teach all you would learn if you were working in a billing office.

You also mentioned working part time with a company.  That is an excellent idea as well.  The absolute best way to learn is hands on.  Start with some research and post any questions you have as you move along.

Good luck!
I am located in Marland area and would like to start a medical claim processing  business. What is the process to starting the business. i never worked in a doctors office,so do I need to take a class. Also, it seems a little hard to land your first client. I love the medical field, I wish I could work with a company part time to get the knowledge before going on my own. Are there any recommendation of how to start the business process of the MIB.
General Questions / Re: Genetic Billing Help
« Last post by sjones@aimabms on June 19, 2018, 03:11:05 PM »
thank you for the response Michele, hope we will be able to find someone who can help!
General Questions / Re: Genetic Billing Help
« Last post by Michele on June 19, 2018, 09:34:46 AM »
I have not done any genetics billing.  Hopefully someone else with experience will see this.
General Questions / Genetic Billing Help
« Last post by sjones@aimabms on June 19, 2018, 09:25:54 AM »
We are a billing company based out of Sarasota, Florida.  We are being approached by many labs in Palmetto region looking for help with billing cancer genetics and pharmacogenetics after z code changes.  Is here anyone with genetic billing experience who can work as a consultant for us?
Patient Billing / Re: Medicare Billing | Rendering Provider
« Last post by avehildebrand on June 18, 2018, 03:58:35 PM »
Thank you Michele!

Patient Billing / Re: Medicare Billing | Rendering Provider
« Last post by Michele on June 18, 2018, 02:13:22 PM »
No you need to complete a CMS 855R form to re-assign benefits to the group.  It's a simple form and is available online at: 
General Questions / Creating a Credentialing Policy
« Last post by Jmojica on June 18, 2018, 02:12:07 PM »
Hello All! Happy Tuesday! I need to create a credentialing policy and could really use some guidance to get the ball rolling. Any advise or guidance?
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