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NPI Numbers / Used wrong rendering but CORRECT group
« Last post by cleefoasis on January 26, 2021, 02:25:47 PM »
Hi all,

The practice is out-of-network with all insurance companies, but we send invoices (superbills) that include NPIs for the clients to submit to insurance. It looks like some invoices may have been sent with two of our providers having swapped NPI's; however, they included the CORRECT group NPI.

A few questions in regard to this:
a) Are there negative ramifications for the individual who's NPI number was used incorrectly

b) What are the health insurance implications of an incorrect rendering NPI number being used- or do they even use the individual # (do they use the organizational #?)

c) Is there a concern that we could be accused of fraud?

d) Any other ramifications?

Thanks in advance to all that help, it is greatly appreciated!! :)
Coding / Medicare Nursing for Denial
« Last post by Billinghelp on January 25, 2021, 12:15:24 PM »
What are the two codes that can be billed to medicare for nursing denials so the claim can be transferred to a secondary payor for processing.
For commercial payers I use 99601 and 99602 for additional hours.
This is for home infusion so I do know that the GY modifier is required, I am just unsure of what codes to use.
HIPAA / Re: HIPAA and References
« Last post by Michele on January 25, 2021, 06:29:53 AM »
I'm not sure I understand what you are asking.  The original question was regarding if a provider dies, or sells their practice.  HIPAA is still very much applicable to the medical billing process as a whole.

I hope that helps.   :)
HIPAA / Re: HIPAA and References
« Last post by alicecarlosmbc on January 25, 2021, 02:08:28 AM »
« Last post by Michele on January 22, 2021, 08:44:08 AM »
My cousin just called me last night with a similar issue.  She needs to learn PCP/FP billing ASAP, mostly vaccinations and modifiers.  Unfortunately I am not aware of any resource specifically for this.  The only thing I can suggest is to post questions on here and get answers.  Sorry! 
HIPAA / Re: HIPAA and References
« Last post by Michele on January 22, 2021, 08:42:43 AM »
Does HIPAA still apply to what?
General Questions / Re: Patient Statements
« Last post by Michele on January 22, 2021, 08:41:38 AM »
We include it in with our fee.  We don't charge separately, we just take it into consideration.
General Questions / Re: Collecting from Clients efficiently
« Last post by Michele on January 22, 2021, 08:41:05 AM »
Hope it works out for you!

Billing / Re: Cryotherapy
« Last post by Michele on January 22, 2021, 08:40:10 AM »
What is the CPT code you are using?
HIPAA / Re: HIPAA Compliant Email Service?
« Last post by Michele on January 22, 2021, 08:36:07 AM »
It works for us.  We use it to send ERAs, and other PHI documents.
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