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Billing / Re: DME Braces
« Last post by Prakalpb on Today at 02:24:45 PM »
As per CMS guidelines patient's 'Home' is not considered as a valid Originating Site for Telehealth Services and my practices' most of the claim has denied for proof of Originating Site address or additional information.
Could anyone please tell me which document is required to substantiate 'Originating Site' information, because patients were at home during Telemedicine service.
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hi Kristin,
I was told it is just a placeholder, they do not actually get charged...do you think it would make a difference if it was a zero charge?
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New! / Re: Collections
« Last post by kristin on May 26, 2020, 10:38:43 PM »
Tough question to answer, I see it from both sides. What does the doctor's financial policy state, that patients have signed? What dollar amounts are we talking about? How many months outstanding is the debt on average?
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Billing / Re: Billing Errors
« Last post by kristin on May 26, 2020, 10:33:00 PM »
Cigna, for most policies, has a 180 day timely filing policy for appeals, based on date of initial claim payment. So while it looks like you are out of luck on the appeal front, I would contact your provider rep, explain the situation, and see if there is anything you/they can do at this point. Submitting a corrected claim probably won't work, due to timely filing issues also. This is an unusual situation, which is why you need a provider rep involved at this point.

My argument with the rep would be that the rendering provider was contracted with Cigna, even if the group was not, a huge mistake was made by the employee, claims were submitted incorrectly, and you would like them to be corrected at this time. Keep in mind if they do agree to do a mass readjustment on all the claims in question, they may ask for all the money back that was paid at the OON rate of 20%, before they reprocess at the in network rate.
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Coding / Re: Prolia med with injection- patient provides own medication
« Last post by kristin on May 26, 2020, 10:16:20 PM »
I know of no modifier for this...the charge for the Prolia supplied by patient should be entered as a zero charge, not a penny. Is there a reason why this isn't being done?
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I don't really know names, but I advice for you to use eastern europe development companies
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Coding / Prolia med with injection- patient provides own medication
« Last post by Ruthie1972 on May 19, 2020, 02:49:34 PM »
Hello,
WE have patients that provide their own Prolia and the charge is entered as .01 as a place holder but the ins company Martins point is still paying for this and then billing the patient for their co insurance.

Is there a modifier that needs to be added to let the insurance company know not to bill or pay for the medication when the patient provides it?
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New! / Collections
« Last post by reliable@epix.net on May 19, 2020, 10:00:32 AM »
Hello,

I was wondering what everyone is currently doing about sending patients to professional collection agencies. 
The Dr's I bill for are split on sending patients at this time, since many are out of work.
What are your offices doing?
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Billing / Billing Errors
« Last post by Uandisolutions on May 18, 2020, 04:34:52 PM »
My practice uses Ability to bill insurance companies for patient sessions. I recently discovered that my former employee had set up the Ability account with the wrong "Billing Provider Info," where the Group NPI was listed instead of the Provider NPI. Unfortunately, since our Group NPI is not contracted/empanelled with Cigna (only my Provider NPI), insurance has been processing payments at the rate set for out-of-network services. This employee had been submitting claims in this manner dating back to 12/2018 totaling well over 150 incorrect submissions. If I am not mistaken, payments for each of the claims submitted to Cigna were at the rate of 20% of the charge amount instead of 100% of the charge/contracted amount minus the co-pay. Is there anyway that this can be retroactively corrected? If so, should we appeal the claims or resubmit them with the correct NPI listed? Lastly, is there a cutoff for how far back Cigna will accept appeals/re-submissions?

Any assistance would be greatly appreciated!
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Billing / Re: DME Braces
« Last post by kristin on May 16, 2020, 10:58:17 PM »
The POS for DME braces always has to be 12, for Home. That said, not sure what is happening here...in order to dispense DME, patient needs to sign a form that says they actually got the DME item. Is that the issue?

An originating site is where the patient physically is when the telehealth call is being made. It can be home, doctor's office, etc...
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