Click here for more sample CPC practice exam questions with Full Rationale Answers

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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

CPC Exam Review Video

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2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

Anthem Changes Timely-Filing (TFL ) Deadlines Effective On October 1, 2019


Anthem has sent out a notice to all providers who have signed non-Medicare (Commercial) or Medicare Advantage contracts with them, stating as, 

“Effective for all commercial and Medicare Advantage Professional Claims submitted to the plan on or after Oct. 1, 2019, the Anthem Blue Cross and Blue Shield (Anthem) Provider Agreement(s) will be amended to require the submission of all commercial and Medicare Advantage professional claims within ninety (90) days of the date of service. 

This means all claims submitted on or after October 1, 2019 will be subject to a ninety ” (90) day Timely Filing requirement.”

Medicare’s rule for timely filing is,“Claims must be filed to the appropriate Medicare claims processing contractor no later than 12 months, or 1 calendar year, after the date the services were furnished.”


Coding Ahead

Anthem Changes Timely-Filing Deadlines

Anthem has sent out a notice to all providers who have signed non-Medicare or Medicare Advantage contracts with them, stating: “Effective for all commercial and Medicare Advantage Professional Claims submitted to the plan on or after Oct. 1, 2019, your Anthem Blue Cross and Blue Shield (Anthem) Provider Agreement(s) will be amended to require the […]

The post Anthem Changes Timely-Filing Deadlines appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

96365 not covered with dx. by Anthem

I have a question regarding covering 96365 antibiotic administration in ED.

Our ED physician documented UTI as final dx. I coded N39.0 for UTI and B96.89 for bacteria according to documentation. in addition, I added R10.11, R10.12, R11.0, and R50.9. Patient received 25 min of IV antibiotic for which I charged 96365.
Antem insurance is not covering 96365. According to CCI/LCD edit the diagnosis are not covered.
Can someone help me to figure out what else I can add so the insurance will cover it?

“UTI without hematuria, site unspecified. Pt. with kuri symptoms of dysuria and hematuria started on Bactrim on Friday. Today developed bilateral flank pain and nausea. Low fever 38.2.consistent wiith pyelo. Labs are normal. She has a few wbsc in urine along with rbsc, but many epithelial cells. Still 2+ bacteria. Will give rocephin and zofram.”

1529-CCI/LCD Edit charge review
-CPT 96365 is not covered. Noncoverd dx. List. N39.0, B96.89, R10.11, R11.12, R10.0, R50.9.

In other example,

final dx. UTI, DYSPNEA.
ED provider documented: no suspicious of ACS or MI, pneumonia. He feels comfortable going home and return if getting worse. His blood pressure stays the same when he stands up.
Urinalysis, microscopic done, blood, EKG, X-RAY. all negative.

Thank you so much for any help,
NIKI

Medical Billing and Coding Forum

Anthem BCBS Denying 2nd Eye Cataract Surgery

Is anyone having issues with Anthem denying/rejecting the second eye cataract surgery within global of the first eye as "modifier used is inconsistent with procedure?"

66984 – RT w/ ICD-10: H25.811
66984 – 79, LT w/ ICD-10: H25.812

We have never had issues before and cannot get through to a live provider or customer service rep. Thank you for any suggestions.

Medical Billing and Coding Forum

Help with billing Anthem and Tricare S9494

I’m hoping someone has an idea what we can do to override a problem we are having between Anthem BCBS and Tricare for Life. We are an infectious disease clinic and many of our patients opt to infuse themselves at home rather than come to the clinic daily. We are not involving a home health agency and provide the patient with all supplies and medications. Anthem requires we bill S9494 with POS 12, however CMS does not allow coverage for this code, therefore Tricare rejects it. Is there any way around this problem, or are we going to have to write off a large sum?

We have since learned from the patient’s account that anytime a federal payer is involved the patient has no choice but to have their infusions in the office due to Anthem’s billing requirements. We are just hoping we may get our original patient paid.

Any help is appreciated, thank you!
Meg W.
Billing Specialist
Infectious Disease Specialists, PC

Medical Billing and Coding Forum

Anthem Pays Largest HIPAA Fine

Anthem paid a $ 16 million settlement resulting from a series of attacks in both 2014 and 2015 that had the potential to expose personal health information (PHI) of 79 million people.  Although they paid the $ 16 million settlement, Anthem does not admit to any wrong doing.  This represented the largest PHI breach in US history […]

The post Anthem Pays Largest HIPAA Fine appeared first on AAPC Knowledge Center.

AAPC Knowledge Center

Georgia Emergency Physicians Sue Anthem Over ER Policy

The MAG (Medical Association of Georgia), alongside the American College of Emergency Physicians, sued Anthem for payment denial of some emergency department services.

Read full story here!

The post Georgia Emergency Physicians Sue Anthem Over ER Policy appeared first on The Coding Network.

The Coding Network

Anthem Investigator Charged with Fraud

A former fraud investigator for Anthem, Inc. is one of five people indicted on federal healthcare fraud charges. Those indicted participated in a multi-year scheme to commit fraud against at least eight health insurance companies. The fraud investigator from Anthem provided the other defendants with confidential Anthem information that assisted them file fraudulent claims to […]
AAPC Knowledge Center

Anthem Denials for Substance Abuse

Beginning March 1, 2018 our California facility began receiving denials for our institutional claims and are now requesting medical records. We are aware that the codes do change twice a year but this is more than that. We are looking for advice from fellow substance abuse billers. Has anyone else been experiencing this?? I would love to discuss codes being used, states that are experiencing this, and all of the above. :confused:

Medical Billing and Coding Forum

Anthem Rescinds Modifier 25 Payment Reductions

Anthem has sent a letter to the AMA to announce  they are rescinding the policy reducing payment for physicians when billing an E/M with a modifier 25 and a procedure that has zero or 10 global days. Anthem was planning on taking a 25 percent reduction on all 25 modified services billed with minor procedures as […]
AAPC Knowledge Center