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MODIFY slip & Fall box 10c claim form

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KARREN:
I have a case fall/trauma at home (PATIENT SLIPPED AND FELLED AT HOME) HEALTH INSURANCE (AETNA, BCBS, UHC AND/OR MEDICARE)  .  Question on the CMS form box 10c (other accident) should this be mark YES.. ??

DMK:
Depending on what type of insurance you're billing, if you say it was an accident the insurance company will want to know what happened and if any other insurance (homeowner's for example) should be responsible for payment.  If it's Blue Cross, Blue Shield or Medicare I, personally would not mark it as an accident.  I'm sure they didn't mean to slip and fall, but you have to define "accident".

Pay_My_Claims:
if what you are billing is related to a fall/accident you MUST answer yes.

PMRNC:
Charlene is right, you don't base how you answer this on what insurance the patient has, it's to be answered honestly. When this comes up, you attach a note to the patient that they should be prepared to submit the details to their carrier. If the patient did indeed fall at home the insurance company can do one of two things.. pend the claim and request information on other policy (home owners, etc) or they can pay the claim with a ROR signed first, meaning the patient and provider if accepting assignment agrees that if a third party pays the claim they have a right of recovery.

DMK:
Mea culpa, you should absolutely tell the patient to be prepared to notify the insurance company of the details of the "accident".  Sorry.

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