Payments > Insurance Payments

billing mathe help

<< < (2/2)

Steve Verno CMBS, CEMCS:
Medical Billing has no magical website that teaches and enlightens someone. 

There are so many outside influences and steps. 

The best way to learn is to undergo instruction with an experienced billign instructor.

Teaching yourself can only open questions you cant answer yourself. 


Fictional Example:

Mary Johnson is 72 years old and works as a greeter for Walmart.  She is provided healthcare with Aardvark Insurance of Alabama.  She also has Medicare Part B.  Walmart has workers compensation insurance with Zenith Healthcare.  Mary cut her hand on a shopping cart and is taken to the emergency room.  To whom do you send the claim?  The claim is for $225.00 with CPT 99283 with modifier 59 and another charge of $175 with 12001 and modifier 51.  The claim went to Zenith.  You get a check from Diversion Insurance.  The EOB shows a charge of $225 and $175.  CPT 99283 is denied as being inclusive with 12001.  The claim went with Modifier 59 on CPT 99283.  The 12001 is paid at $49. The reason for the difference between $175 and $49 is listed as a PPO discount.  Your office manager says to bill the patient the $225 denied and the difference between the $175 charge and $49 payment.  What do you do??

OK here is something I worked on Today:


Bob Hope(Not real name) was seen in September 2005.  He presented himself as an uninsured patient.  he was billed x 3.  His account went to a debt collection agency.  Today, he calls the collection agency and says his visit was due to workers compensation. The collection agency calls you and asks you what to do?. They got a call from Mr. Hope's lawyer saying he is being illegally billed for workers comp.  In september 2005, he worked for Barnum cruise line.  They are now out of business. The pateint's lawyer  calls you and says to send the claim to Midland Insurance Company in orlando, Florida.  You call them, they never insured Barnum for workers comp. The State has no record of this injury on file.  You inform the patient of this.  The patient calls his lawyer who calls you back and says you have to send a claim to Midland Insurance Company.  The Lawyer faxes you a complaint he has made with the state saying you are now in violtion of State Law.  What do you do???

Navigation

[0] Message Index

[*] Previous page