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71
Billing / Medicare Crossover claim to medicaid
« Last post by HPATEL on February 08, 2018, 02:09:57 PM »
How to tackle the following obstacle by GA Medicaid?
1   0984   MEDICARE CO-INSURANCE MORE THAN 20 PERCENT MEDICARE ALLOWED AMOUNTED
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Coding / OT 97165 and 96111
« Last post by June Lawrenz on February 08, 2018, 12:56:28 PM »
Speech therapy clinic that has just taken on an OT. Therapist sent me 97165 (OT Eval) with 96111 (extended testing). Not sure if I misread or misunderstood the CCI tables, but billed 96111 as the primary CPT (from column 1), and was told by a fellow biller to use Modifier 59 on each line (column 2 shows Modifier is allowable with 97165). Insurance paid 96111 but denied 97165 as "service is included in the payment/allowance for another service". Of course the insurance gives the standard response of "we aren't allowed to tell you how to code" so I'm struggling to figure out where my error is. Any advice?
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General Questions / Re: Medicare Modifier Help, Please...FY, TC specifically
« Last post by PippiT on February 08, 2018, 09:47:31 AM »
I got a CSR that was a little more helpful.

She said:

If the x-rays were done twice, on the rejected  one, the TC needs to be first modifier

If no, the 26 modifier needs to be removed and the FY needs to be added for the type of film used.

I'm still confused but not as bad. I just need to verify 2 sets of xrays were done because the notes aren't very clear to me.
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General Questions / Re: Medicare Modifier Help, Please...FY, TC specifically
« Last post by PippiT on February 08, 2018, 09:22:52 AM »
So the 73630 RT FY TC was denied stating "unprocessable"?  Is that the only denial information?  The FY should only be on the TC portion of the xray and I don't see where it matters if it's in the first location or the second.  I would first check to see if there is any other denial codes.  If not, I would call and ask for additional explanation of the denial.  They may be able to point you to an LCD or NCD.  To me it appears to be coded correctly.

Denial codes are as follows:

CO-4: The procedure code is inconsistent with the modifier used or a required modifier is missing.

M20: Missing/Incomplete/Invalid HCPCS

MA130: Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.

N519: Invalid combination of HCPCS modifiers.

I will call again and see if I can get someone more helpful. The one I spoke to yesterday said he couldn't tell me what modifier to use, I wasn't asking him to I just wanted to understand that is when I googled and found those links.
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General Questions / Re: RCM Audit
« Last post by anesbillingbridge on February 08, 2018, 04:35:58 AM »
Any one please suggest who give Free RCM Audit Report.
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Billing / Re: Billing CPT 90837 with add on code 90863
« Last post by Michele on February 07, 2018, 08:23:02 PM »
Is the provider contracted with BCBS?  Did he receive any notification of any changes?  I would call BCBS to ask for an explanation on why the payment amount changed from 2017 to 2018.
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General Questions / Re: Medicare Modifier Help, Please...FY, TC specifically
« Last post by Michele on February 07, 2018, 08:21:03 PM »
So the 73630 RT FY TC was denied stating "unprocessable"?  Is that the only denial information?  The FY should only be on the TC portion of the xray and I don't see where it matters if it's in the first location or the second.  I would first check to see if there is any other denial codes.  If not, I would call and ask for additional explanation of the denial.  They may be able to point you to an LCD or NCD.  To me it appears to be coded correctly.
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General Questions / Re: Medicare
« Last post by Michele on February 07, 2018, 08:12:26 PM »
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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Billing / Re: shipping code for pharmacy work comp
« Last post by Michele on February 07, 2018, 08:09:33 PM »
I do not know of any code for shipping.  I don't even find an unlisted code that would be appropriate.
80
Billing / Re: Collection Agency Recommendations
« Last post by Michele on February 07, 2018, 08:06:25 PM »
We have tried several different avenues for collections.  The best we have every had by far is working with Transworld.  They are a national company.  The rep we use is Dick Neary.  You can reach him at dick.neary@transworldsystems.com or 941-350-9918.  We do not get anything for referring people, they are just really good so we refer.  But tell him we sent you, he does like to hear where you got his info from.  They have a different approach to collections and it is VERY effective.
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