Recent Posts

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Coding / Re: Modifiers with UHC
« Last post by Michele on September 16, 2021, 05:30:03 PM »
We bill for several DCs as well.  We have found that UHC requires us to bill the modalities with the GP modifier even though it's not a PT performing the service.  I am not aware of any other way to bill for the modalities.  No other modifiers describe the service.  They should not be counting it against the PT though, that doesn't seem fair.
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Coding / Modifiers with UHC
« Last post by ECBSJC on September 15, 2021, 12:05:49 PM »
I am billing PT modalities (97110, 97140 and 97014) under a Chiropractor with UHC.  When I bill the claim without using any modifiers, the modalities are denied for not using the proper modifiers.  When I bill the claim with GP modifiers (still under the Chiropractor), the claims are processing out under the PT visit limit.  What modifiers should I be using to show that these are PT charges billed by a Chiropractor, to ensure the claims are processed under the Chiropractic visit limit?
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New! / Re: Anthem KY Claim Payment Issues
« Last post by Michele on September 14, 2021, 11:24:15 AM »
The only contact we have for Anthem of KY is for credentialing issues.   :(

Do you have a provider rep?  If not, I would contact the provider relations department and ask for a supervisor.  Sorry, that's the only option I see.

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New! / Anthem KY Claim Payment Issues
« Last post by Nick D on September 13, 2021, 04:49:07 PM »
Anyone have issues with timely payments from Anthem of KY or have a good contact for an executive at Anthem? I am getting crushed for a number of reasons and can't get them to pay consistently.
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General Questions / Re: Medicare reassignment of benefits
« Last post by Michele on September 07, 2021, 11:52:45 AM »
I don't believe there is a limit to the number of reassignments.  It is common for a doctor to work at multiple groups and reassign benefits to the group. 
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General Questions / Re: Advise Needed: Diagnosis assignment
« Last post by psychson on September 03, 2021, 07:26:52 PM »
Iíve been working with mental health billing for almost 20 years and YES,  clinical staff, clinician assigned to client/patient should be responsible for inputting a valid diagnosis. As someone already pointed out, it can take 2 or 3 initial assessment to be able to get a diagnosis, however it's no excuse for not having a preliminary one either or not wanting to do the work and use a generic Dx.

There are two questions:
1.   Why do they want it automated ?
2.   Do you need to submit billing as soon as it is entered? Whatís the hurry to have a Dx. entered?

You are allowed to bill with a preliminary diagnosis for the first few visits and later have a more comprehensive and "final" diagnosis and change it to bill accordingly.

I would say It's up to your workplace  to "babysit, spoil" clinical staff and add a generic diagnosis or even automat it, but eventually it must be updated and clinicians  are the ones responsible for doing it. Billing staff should refrain from editing anything related to clinical, even it is preventing you from billing. 

You are not saying what type of insurance you are billing, but no matter which one, if Medicare, Medicaid,  HMOís & PPOís or even if itís a state/county/city grant you must follow guidelines for each contract you have and not do things that may penalize you when an audit comes along.

In the end of the day billing should do only what is billing related and no matter how much clinical staff whine about it, itís not a biller job to input diagnosis. The opposite is also true, it's not a clinician job to submit billing when your billers go on vacation.
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General Questions / Medicare reassignment of benefits
« Last post by psychson on September 03, 2021, 03:52:55 PM »
Hi,

Does anyone know if a doctor can work in private practice and bill Medicare  and at the same time reassign his Medicare benefits to a third party, such as a clinic/agency he also works as independent contractor?

Or better yet, how many medicare reassignment of benefits Medicare allows ?

Thanks
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New! / Re: Can u find the Medicare ID if you have the SS# ? How? TY
« Last post by Michele on September 02, 2021, 10:16:30 AM »
If you have web access for your local MAC they have an "MBI Lookup tool".  That allows you to put in the name, DOB & SSN and they will give you the Medicare ID#.
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NPI Numbers / Re: Can u find Medicare ID if you have the SS# ? How? TY
« Last post by Michele on September 02, 2021, 10:16:03 AM »
If you have web access for your local MAC they have an "MBI Lookup tool".  That allows you to put in the name, DOB & SSN and they will give you the Medicare ID#. 
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New! / Can u find the Medicare ID if you have the SS# ? How? TY
« Last post by tmgastro@comcast.net on September 01, 2021, 10:44:48 AM »
Can u find the Medicare ID if you have  the SS# ?  How?  TY
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