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Investigation included 55 million records from 2019. Adjustment codes are sometimes too vague to clearly identify whether a Medicare Advantage Organization (MAO) denied payment for a service, the Office of Inspector General (OIG) concluded in a February 2023 Issue Brief. Without specifics about the services for which the MAO is denying payment, the OIG cannot […]
The post Ambiguity Surrounding MAO Claim Denials Hampers Fraud Detection appeared first on AAPC Knowledge Center.
Follow COB rules to determine when care may be covered by another payer. Coordination of benefits (COB) can be described as when two or more insurance plans work together to determine the order of coverage liability. This coordination between plans exists to avoid duplicate payment, which could result in a provider receiving payment in excess […]
The post Prevent CO-22 Claim Denials appeared first on AAPC Knowledge Center.
The No. 1 claim error for June in 11 states plus the District of Columbia was for non-covered charges, according to Novitas Solutions, Medicare Administrative Contractor for Jurisdictions H (Arizona, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma, and Texas) and L (Washington DC, Delaware, Maryland, New Jersey, and Pennsylvania). This error is identified by Explanation of […]
The post Top Claim Error Revealed appeared first on AAPC Knowledge Center.
d7240- removal impacted tooth 32
d7240- removal impacted tooth 32
d7241- removal full bony impaction, difficult
d9239 intravenous moderate (conscious) 1st 15
d9243- intravenous moderate (conscious)
d9610- therapeutic parenteral drug-single admin
Thank you in advance for any input.
Kate
What are the requirements for submitting the corrected claim to fix the error? Do we HAVE to submit a corrected claim? Is there an exclusion when the patient is pregnant?
Is this something i just have to appeal and how do i appeal a timely denial when the original claim was submitted within the time limit?
Thanks,
Cortney!
A resigned New Haven oral specialist and his training consented to pay more than $ 250,000 to settle charges that they damaged government and state false case laws.
The post Resigned New Haven Oral Surgeon Settles False Claim Allegations appeared first on The Coding Network.
I am wondering if someone would be able to help me with a claim denial. Our practice billed out 99472 with a modifier 25 for the provider. The same day the same provider provided sedation; the sedation code billed out was 00635. The claim for 99472-25 was denied for NCCI edit. The insurance provider stated that it was most likely a wrong modifier?
Thank you, in advance of any suggestions or help you may be able to provide.
Thank you for any assistance provided!
Annette Vesey, CPC-A