Recent Posts

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Starting Your Own Medical Billing Business / Re: Advice Needed!
« Last post by kristin on November 30, 2021, 11:11:39 PM »
Out of curiosity, what is the special software that will help you work with medical professionals directly?
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Starting Your Own Medical Billing Business / Re: Advice Needed!
« Last post by constharper on November 30, 2021, 09:18:43 AM »
As is often the case in business, the hardest part is actually finding your first client. I advise you to show restraint, get involved in marketing and not lose faith in yourself and your business! I also advise you to work with medical professionals directly and special software will help you with this.
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General Questions / Re: Is this considered fraud?
« Last post by kristin on November 29, 2021, 09:38:57 PM »
Agree with Michele completely, definitely mention it to your boss. To me, this sounds like a case of "ignorance/error" when it came to what codes to bill, and not fraud. I am not sure how old these claims are, but it could stand to reason that whoever she was using for billing for whatever reason didn't switch from testing codes to vaccine codes, when the vaccine became available.

I have no idea if testing codes pay more than vaccine codes, but if they do, or vice versa, your boss could either owe money or be owed money from insurances, if these are paid claims.
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General Questions / Re: Is this considered fraud?
« Last post by Michele on November 29, 2021, 12:53:48 PM »
I would definitely mention it to her.  You may be wrong, but if it is being done wrong it should be corrected.  If it's a clerical error, and it's corrected, it's not fraud.  But if it's being done to get a higher reimbursement then it certainly is.  But the coding for the vaccine is very different than the coding for the testing.  For example, the dx for the vaccine is Z23.  The dx for testing would be different, like either the symptoms the patient has, or exposure.  so the Z23 dx wouldn't work with a cpt for testing. 
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Billing / Re: EECP treatment (G0166/92971) - substitute CPT code?
« Last post by Michele on November 29, 2021, 12:46:51 PM »
I don't see that there is any issue with CPT 92971/G0166.  It hasn't been deleted or replaced.  The provider should be aware of the denial and working with the insurance to rectify.  Do you know if the provider has contacted HMSA?
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General Questions / Is this considered fraud?
« Last post by Msladyajw on November 26, 2021, 12:12:46 AM »
I recently took on the task of helping my new boss clear some claims that were denied because of wrong credentials,
Upon reviewing some of the claims I noticed the billing code being used is what is used if you performed a covid test, But it should be for giving a covid vaccine. Could this be considered fraud? The billing is usually done by a company and I do not think she knows this is being done, But I do not know for sure, If this is not fraud I have no need to mention it but if it is or isn't I have no clue. The company I work for is not a DR or clinic. They do vaccination events, They have a NPI but they never did billing for anything until the COVID vaccine, SO I am thinking she most likely does not know, Should I mention this or just keep my mouth shut
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Billing / EECP treatment (G0166/92971) - substitute CPT code?
« Last post by simpham on November 24, 2021, 10:07:20 PM »
HMSA denied my ECP claims because the code 92971/G0166 is no longer in their list.
Could someone let me know the substitute code for EECP treatment?
Thanks!
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Coding / Re: Occupational Therapy Extended Testing
« Last post by June Lawrenz on November 23, 2021, 09:47:42 PM »
Thank you.
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NPI Numbers / Re: Do I need a NPI?
« Last post by RichardP on November 19, 2021, 10:00:44 PM »
 :)  You are welcome.
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Coding / Re: Occupational Therapy Extended Testing
« Last post by Michele on November 19, 2021, 02:45:53 PM »
Hmmmmm.  So it sounds like it may just be an error on their part, but like you said you have to hope they don't decide the error was in paying, and they reprocess and take back the money on the other claim.  But from what I see it appears to be allowed separately.
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