Author Topic: Billing for denial  (Read 1388 times)

labops

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Billing for denial
« on: November 24, 2013, 05:23:56 AM »
I was always told that if a service is performed it must be billed. If a payer has a guideline which states the service is not medically necessary, yet was performed, should it be included on the cms 1500? I am trying to find a ruling either way. Thanks to anyone who can help!

PMRNC

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Re: Billing for denial
« Reply #1 on: November 24, 2013, 12:35:50 PM »
Quote
I was always told that if a service is performed it must be billed. If a payer has a guideline which states the service is not medically necessary, yet was performed, should it be included on the cms 1500? I am trying to find a ruling either way. Thanks to anyone who can help!

This is very vague..

a service is performed it must be billed.   to whom? contract? non contract? Medicare? AOB?

Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

labops

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Re: Billing for denial
« Reply #2 on: November 24, 2013, 02:17:55 PM »
Specifically, we perform specific tests intraoperatively and the carrier (in this case Aetna) considers some not medically necessary. They are telling us not to include the codes on the CMS 1500, and that we should only bill for those test covered in their guidelines. Thanks for any insight you can provide

Merry

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Re: Billing for denial
« Reply #3 on: November 24, 2013, 05:10:17 PM »
If it a procedure that is not medically necessarily, you would or should have the patient sign an agreement that they have been informed that this could not be billed to the insurance co. and they would be personally responsible for the bill if you chose bill for these tests. but if they are deemed not medically necessary I would be leary billing the patient. JMHO.

Merry

Merry