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Ask the Biller

Do you have a question for Ask the Biller?
Here's your chance to speak up.

We answer each question we get as best we can from our experience with 14 years of medical billing.   

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Enter here.  Medical Billing Forum. 
 

If you have a more involved medical insurance problem and need help handling it, call us about our consultation service at 1-800-490-4299.

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We've been getting emails from our readers asking where all the current "Ask the Biller" questions are.  We're still getting and answering them, but it was getting out of control!! 

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Question for Ask the Biller:
December 4, 2007
Hi
Can you please tell me how to bill 2 E&M codes on the same day for 2 physicians in the same practice with the same tax ID#, but with different specialties? I know with the same tax ID, same specialty only, one E/M code per day will be paid, but I can’t find anything that says how to bill it with different specialties.
Thanks,
Stephanie


Response from Ask the Biller:
Hi Stephanie,
I personally haven't come across your situation in the billing I've done but I did a little research. The only thing I can suggest is to try billing out the second E&M with a 59 modifier. This modifier indicates that the 2nd E&M is a distinct procedural service. I’m not sure that all insurance carriers will honor the 59 modifier and pay for both E&M’s but that is what I would try. Make sure you have different dx's on each E&M. If that doesn't work, your only other option is for the patient to schedule the appointments on separate days. Hope that helps!
Michele

Question for Ask the Biller:
December 4, 2007
When billing for a nebulizer in a physician's office; is it appropriate to bill for the tubing/mask as well, or is that bundled or only appropriate if you are a dme vendor?
Bridget


Response from Ask the Biller:
Hi Bridget,
If the tubing & mask are disposable, you should certainly bill for them. Not all companies will allow for them separately, but some will. If you need to bill Medicare for them then you would need to obtain a Medicare DME supplier number. Hope that helps.
Michele

Question for Ask the Biller:
December 4, 2007
I was wondering if you need to put a remark on a UB04, where could it go? That is excepted by the insurance companies
Thanks for your help
MICHELLE B


Response from Ask the Biller:
Hi Michelle,
There is a box for remarks on the UB04, it is field 80 on the bottom left hand corner. It has four (short) lines. That is the only spot specifically for remarks. Thanks
Michele

Question for Ask the Biller:
December 3, 2007
Hi my name is Linda and I am the billing manager for a pediatric office. When we see a sick child for wheezing and/or tightness in the chest we usually bill 99213 for office visit and give them a inhalation breathing treatment under procedure code 94664 but we never get reimbursed for the treatment only the office visit.  How do I get insurance companies to consider procedure 94664 am I billing this correctly?
Linda


Response from Ask the Biller:
Hi Linda,
When you see the patient for the wheezing/tightness and you do the 94664, I would recommend trying a 25 modifier on the E&M code indicating that the E&M was a Significant, Separately Identifiable E&M Service by the Same Physician on the Same Day of the Procedure or Other Service.
Also, if you have more than one diagnosis and if it is appropriate to use a different diagnosis for the E&M than you use for the 94664 that may help. For example, if a child comes in with an upper respiratory infection, and you give him a breathing treatment for the wheezing/tightness, then you could bill the 99213 with dx URI and the 94664 with the wheezing/tightness diagnosis.
Hope that helps.
Michele

Question for Ask the Biller:
November 23, 2007
Hi Alice,
I have a question in regards to C-Leg repairs …..payment from Medicare…..how are other DME providers submitting there claims and getting paid….I hope you have some insite on this matter
Happy Thanksgiving..Thank you Marilynne


Response from Ask the Biller:
Hi Marilynne,
I’m afraid I am not familiar with billing for CLeg repairs. I did some research but the only thing I could find was that if the CLeg was medically necessary the repairs should be covered. I will post the question on my site and maybe someone out there will be able to send a response.
Is there anyone reading this familiar with this problem? We would greatly appreciate your help with this one.
Sorry I wasn’t able to help.

Michele

We received this email Jan 23, 2008

We billed Medicare for repairs for one of our patients that has a C-Leg. We billed about $8000 for the repairs and Medicare only allowed around $600. We appealed the claim all the way to an ALJ Hearing level. At the hearing level the decision was favorable, but we are still waiting for payment and the repairs were done over a year ago. We have found that if the C-Leg is out of warranty it is easier to get Medicare to pay to replace it then to pay to repair it.
Jane

Thanks Jane


Question for Ask the Biller:
November14, 2007
How do you complete the HCFA 1500 form when using a Locum Tenen?

Response from Ask the Biller:
Hi,
You should be using the locum tenen’s individual NPI & legacy numbers in box 24 J, and their name in box 31. Then the group name address and GROUP npi in box 32 & 33.
Thanks
Michele

Question for Ask the Biller:
November 12, 2007
I am having trouble sending sec electronic claims—I continue to get two error messages—Please help
1. Line adjudication date invalid
2.paid amt does not match service line amt
I use Medisoft v.11 I submit through Availity's Clearinghouse. Medicare is requiring that I submit sec claims electronically and I can't get the errors figured out.
Thank you,
Kelly


Response from Ask the Biller:
Hi Kelly,
I had a similar problem and I use Lytec (very similar to Medisoft). Are you using claim manager to submit? I think the problem is that when you enter the primary payment you need to enter it on each line item, not just as one payment on the entire claim. For example, in Lytec I usually enter payment for the claim as an IP (insurance payment) on a new line on the claim, but if I am submitting the claim to Medicare as a 2ndary, then I have to hit F5 on each line item and enter the payment for each service separately. I’m not quite sure how to do that on Medisoft, but it is the same error that I received. But if you are using Claim Manager you can send an email to support@sendclaim.com and they will help you with all the errors. If you use something else then you should contact your support. They will be able to help you.
Thanks and Good Luck!
Michele

Question for Ask the Biller:
November 6, 2007
What procedure code would I use, since we are not the MCP, but we are following the pt care while they are on vacation? I have conflicting information one document says to use the 90999 x units, the other says to use the G0327 which states for home dialysis but pt is @ outpatient dialysis center.
Thank you
Beverly


Response from Ask the Biller:
Hi I wouldn’t recommend using the 90999 since it is not a reimbursable code. I would use the G0327 with an appropriate place of service code to indicate outpatient dialysis center and use the facility address in box 32.
Michele

Question for Ask the Biller:
November 7, 2007
Hi,
If a physician is like Dr. J. Y. Park, P.C.
does that dr need a group NPI and an Individual NPI?
She says Medicare has started denying her claims because she didn't have a group NPI.
She is the only dr in the practice. I have 3 other drs who are the only dr in their practice they all have one individual NPI. Are they all going to have this problem?
Cathy
Thanks a lot


Response from Ask the Biller:
Hi Cathy,
If the Dr is a professional corporation (PC) then yes, she does need a group NPI as well as an individual NPI even if she is the only dr in the PC.
Thanks
Michele

Question for Ask the Biller:
November 6, 2007
Hi Alice,
We have reason to believe that the IPA that we are participating with is not accurately reimbursing our practice.
We believe we found the Medicare fee schedule for our locality at
http://www.medicarenhic.com/cal_prov/fees/2007revfee2_area18.pdf; however, the IPA says we are contracted at 100% of the RVRBS fee schedule. We are wondering if this is the same fee schedule as the Medicare fee schedule for our locality or not. Where can we find an online copy of the RVRBS fee schedule to verify our reimbursements?
Thank you again!
Denise


Response from Ask the Biller:
Hi Denise,
I'm not sure what IPA stands for, but I know that we have local insurance carriers that calculate their allowed amounts based on a formula that includes the RVRBS. It is not the exact fee schedule that Medicare allows but it is calculated based on the Medicare fee schedule. I suspect this is the same thing. I would suggest asking the IPA exactly how they calculate their allowed amounts. They should be able to tell you the formula.
I hope that helps.
Michele

Question for Ask the Biller:
November 6, 2007
Hi,
How would I bill Florida Medicare for ESRD related care for a transient pt visiting Florida for less than a month? Is the 90999 code still applicable?
Beverly


Response from Ask the Biller:
Hi Beverly,
If the patient is Medicare eligible, you would just bill for the ESRD the same as you would any other Medicare patient. It wouldn’t matter if the pt were transient, or how long the patient was in Florida.
Michele

Question for Ask the Biller:
November 2, 2007

My name is Julie and I am billing for family practices. How can we bill for a pap smear to private insurances. The doctor is billing a 99214 and did a pap and has 2 other diag's for other things but it was not a well exam. I have used the S0610/12 codes and they were paying then stopped paying. I am using the V72.31 also. Even if it was a well exam it seems that the Dr. should get paid for the pap smear because of the time involved.
So just want to know certain codes to bill.
Thanks for your help and I am glad I found your website, you have great info.
Julie


Response from Ask the Biller:
Hi Julie,
If you are billing for a pap smear to private insurances you should try billing with cpt code 88164. Whether the dr is doing a well exam or a medical visit, the pap should be billed out separately.
Thanks
Michele

Question for Ask the Biller:
October 24, 2007

What is the ID qualifier for other payer name? What is the PIN and ID qualifier in the Referring Dr Tab, needed to be? Is there a list of these ID Qualifiers I can print and if so do they explain where they are required to be for claim processing electronically? I use Medisoft version 12
Sincerely
Nellie


Response from Ask the Biller:
Hi Nellie – Here's a link to my blog where the are listed. You will find them there. Thanks for subscribing to our newsletter.
http://solutions-medicalbilling.blogspot.com/2007/10/qualifiers-for-medisoft.html
Alice

Question for Ask the Biller:
October 19, 2007

For Physical Therapy Home Care to a No-Fault Patient in New York, I was told that the reimbursement is 50% greater than service in an office setting. Do you agree with that, and do you have supporting documentation?
Artie


Response from Ask the Biller:
Hi Artie,
I don't have any supporting documentation, but I do not agree that the reimbursement is 50% higher. I have billed for some services provided in the home in the past and the reimbursement is greater, but not by 50%. I will soon be billing for PT in the home but at this time I'm not. Make sure you indicate that the services were in the home by using the 12 place of service code and bill your regular fees so that you are allowed the difference.
Good luck
Michele

Question for Ask the Biller:
October 17, 2007
Dear Biller,
I'm a dermatologist in NYC and I'd like to run a two-part undercoding question past you: Can you bill for an office/outpatient surgical excision (11401) and complex closure (11301) without billing for the office visit (99202); and if so, will the commercial carrier reimbursement be higher for the above two surgical procedures (when excluding the office visit)?GC


Response from Ask the Biller:
Hi Gil,
Thanks for the question. Yes, you can bill for just the 2 surgical procedures without billing for an office visit. There is no rule that you MUST bill for the office visit, even if it is the first time you're seeing the patient. In answer to your second part of the question, not billing the office visit should not increase the reimbursement for the 2 surgical codes. Each insurance carrier allows a certain fee for each CPT code. Office Visits do not change the fee. I would think you would be reimbursed more if you did bill the office visit code with a 25 modifier. This way they would allow the fee schedule for the office visit and for the 2 surgical procedures.
Michele

Thanks for your quick and helpful response. Your reply confirmed my general thinking on this subject, and I appreciate your succinct and clear explanation.
With much appreciation,
Gil


Question for Ask the Biller:
August 16, 2007
Hello,
I am a Cardiologist Recruiter for Alliance Recruiting and have a client in FL who wants to utilize locum tenens. We have a Cardiologist who is available for a locum to perm position from Sept 3 – Dec 21. This physician is not covering for vacancy or vacation. The Cardiology group is recruiting for a permanent Cardiologist but are going to have the physician start off as locum tenens to see if it is a good fit for the practice.
The client is concerned that they will not be able bill Medicare for the locum docs procedures after 60 days. She says FL Medicare is strict with locum tenens and cannot bill beyond 60 days. Is this correct? Surely there are other groups/hospitals who have used locums for MD’s longer than 60 days.
Please let me know
Thanks,
Jessica


Response from Ask the Biller:
Hi Jessica,
Michele did some research but she didn't come up with any more than you did. Being that we’re from NY and this is a Fl rule, we haven’t had any experience with it. I'll put it up on our “Ask the Biller” page and see if someone else can help you. It sounds as if the break in assignment would work, but we really don't know.
Good luck.
Alice

How about it? Has anyone had any experience with this? Please reply and I'll let Jessica know. Thanks

Question for Ask the Biller:
August 12, 2007
Hello!
I graduated from Penn Foster School this past November in Electronic Billing and Coding. I 've been keeping up with coding news by reading AAPC magazine. Should I be coding now from the ICD-10-CM manual? Why is all the advertising sells ICD-9-CM still but not the other manual? I'm really confused.
Also can you help me find somebody that's actually coding from home?
Thank you!
Walter


Response from Ask the Biller:
Hi Walter,
We've been hearing about the ICD-10 for a long time, but we haven't seen it yet. We are still using ICD9s and haven't heard about an actual date for the use of the ICD-10 yet.
Are you signed up for our newsletter? In the August issue I just sent out last week, I write about where to find current ICD9 codes with a link to a website where you can look them up free of charge. We've had very good luck with that website.

We're in the process of making our “Ask the Biller” page more interactive so when I put up your question, I'll ask if anyone who codes from home is willing to contact you.
If I hear any more about the ICD-10s I'll contact you.
Alice
So is there anyone out there who does coding at home and would like to contact Walter, send me an email and I'll send it on to Walter.

Question for Ask the Biller:
August 5, 2007
Hello,
I did not understand in what way the SOCIAL WORKERS AND MARRIAGE COUNSELORS are related to claim a medical bill.
Why they do need a NPI# ? Please let me know in what way they treat a patient and claim for reimbursement.
Thanking you
Jagdish


Response from Ask the Biller:
Hi,
Thanks for your question.
Many social workers and/or marriage counselors can bill insurance companies for their services. It depends on the insurance company if they reimburse for the services or not. A counselor can contact the insurance companies to see if they credential the type of counselor they are or not. Most insurance companies will credential LCSW's. Some will credential marriage counselors.
If a social worker, or a marriage counselor bills insurance companies for their services then they need an NPI number.
Hope that is helpful.
Thanks
Michele

 

June 27, 2007
Hello Alice,
We are an ancillary network provider, and we only coordinate the care, services, and supplies for workman's compensation. Are we required to have an NPI?
Thank you,
Melinda


Response from Ask the Biller:
Hi Melinda,
This is one of those gray areas. If you call the NPI enumerator they wouldn’t even be able to tell you. The law states that all Medical Services Providers must have one. You don’t get reimbursed by health plans but you may need one to coordinate the care.
Bottom line, they are free and you are probably better safe than sorry. If I were you, I would do the application. Worse case, you will get an NPI number assigned, but never use it. Doesn’t sound too bad!
Good Luck
Michele

Question for Ask the Biller:
June 18, 2007
Hi Alice,
Would you know when the UB04 form must be used in place of the UB92?
Thanks, Nancy O.


Response from Ask the Biller:
Hi Nancy,
Good to hear from you.
Yes – effective May 23, 2007 you should be submitting the UB04 form. There was no extension granted as far as we know.
Alice

Question for Ask the Biller:
June 18, 2007
Do you know what is required for fields 32b and 33a on the new 1500 forms for uhc and acm and also Tricare.
thanks
Betty


Response from Ask the Biller:
Hi Betty,
Box 32b should be the group’s insurance PIN number. If you do not have a group PIN number, then you should use the rendering provider’s PIN number. Box 33a should be the group’s NPI number (Type II NPI). If you do not have a group NPI number, then you should use the rendering provider's NPI number. Bottom line, for most insurance carriers, payment is going to be made to whomever's NPI number is in box 33a. These rules should be the same for UHC, Tricare, and ACM.
Thanks
Michele

Question for Ask the Biller:
June 8, 2007
Hello there,
Quick question. We perform retrospective work for clients and submit corrected claims on their behalf. Since we review claims 10 months prior to the May 23rd conversion date of the UB04, do you know if payer(s) would require us to use the NPI number on older claims that were originally billed under the UB92?
Thank you
Jim B


Response from Ask the Biller:
Hi Jim,
Yes, the NPI number is required on all claims after May 23 even if they have dates of service prior to the May 23 date. Some companies will not deny these claims as all are not yet on board with the NPI's. It would be best to be submitting them with the NPI's now.
Alice



Question for Ask the Biller:
May 16, 2007
Is there a website or resource that you can purchase guides regarding billing services for certain practices such as psychiatry? I bill for speech and audiology services and they have an excellent website I can access for information. I have started doing medical billing at night as a second income. My daytime job is billing and insurance for a speech clinic. There may be different specialties I will be billing for and would love to have something to reference such as a book or a website.
Thanks,
Stephanie



Response from Ask the Biller:
Hi Stephanie

Not that we are aware of. We will soon be releasing videos and ebooks of billing for specialties. We’re starting with specific instructions on completing a CMS 1500 form correctly and completely. Next we will do specialties starting with mental health, vision, chiropractic, physical therapy, and family practice. This might be something you would be interested in. Hope to have the first ready by the beginning of June. Let me know if you would be interested.
Alice

Guess What!!

Our Ask the Biller page got out of control. It's too big. We had to archive some of it. To read questions and responses from July 25, 2005 to May 15, 2006 go to the
"Ask the Biller Archives".



Be sure to check out our Books

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"The Basics of Medical Billing"
This book is designed for the everyone in the medical office to improve the efficiency of the office and increase the cash flow. It explains all the basics of how medical insurance billing works in simple terms anyone can understand. For more information.



  
"How To Complete a CMS 1500 (HCFA 1500) Completely and Correctly
Line By Line,
Box By Box"

ebook.  

This 40 page ebook explains in terms a medical biller will understand exactly what information is required and where to put it on the new CMS 1500 forms with specific details. 

Here's more information and an excerpt from
"How To Complete a CMS 1500 (HCFA 1500) Completely and Correctly - Line By Line, Box By Box"

Avoid unnecessary denials and stop loosing money on your medical insurance claims by completing the form correctly the first time. You can save many times the cost of this book on your first claim.  

You will need Adobe Acrobat Reader to read the report.  You can download the newest version here at Acrobat Reader.



Alice & Michele
Alice and Michele 



Solutions Medical Billing Inc. offers a
consultation service
for more involved problems with medical  insurance billing.  If you have a problem with your medical insurance billing you would like us to handle, you can reach Michele or Alice at
1-800-490-4299.   Call for pricing.








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Solutions Medical Billing Inc. offers a
consultation service
for more involved problems with medical  insurance billing.  If you have a problem with your medical insurance billing you would like us to handle, you can reach Michele or Alice at
1-800-490-4299.  

Call for pricing
.





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