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Unlisted L-Code (L8699) and claim rejection
facility claim reimbursement
2 claims one for physician and one for facility both cms1500
On the Physician claim do I use rendering NPI and modifier 26 on each cpt?
ON the facility claim do I use no NPI except that of group/entity and then a TC on all CPT?
NEED HELP QUICKLY, please.
Medical Coder / Claim Edits
I am in search of a remote medical coder/ claim edits position
Previous experience handling claim edits for wound care management.
Thank you, have a great day.
Key documentation criteria for supporting the Medicare claim
Corrected Claim VS Voiding claim: What would you do??
The scenario:
Physician office files a claim to Medicaid MMA and after claim is submitted a commercial insurance is discovered that the patient had not reported to either Medicaid or our office. Our office reports the commercial insurance to the MMA and files a claim to the commercial insurance.
In the meantime the MMA pays claims and then the commercial insurance pays claim, now the claim is overpaid.
I have been resubmitting the claim to the MMA as a corrected claim with a copy of the EOB from the commercial insurance. My thought is that the MMA will see the commercial insurance payment and reprocess their claim and ask for a refund of the overpayment.
What is routinely happening is the MMAs are denying as a duplicate when the claim is clearly marked with a submission code 7 with the claim # references.
My other option would be to submit a voided claim but I feel this is not correct as the service was provided so I do not feel the void would be appropriate.
This is a huge problem for our office. Patients routinely do not disclose their commercial insurance as they do not want to pay ANYTHING and think that if they dont disclose they commercial insurance will not be eventually discovered.
How would you handle the overpayments on the claim?
Verify claim accuracy for ICD-10
Documentation terminology that will not support the Medicare claim
Compliance tip: The relationship between the assessment and the claim
Claim denial 10060 for I&D sebaceous cyst
I recently got a denial for a claim where a sebaceous cyst was drained from a patient’s face (LT cheek). ICD-10 code was billed as L72.3 with CPT code 10060. I checked the LCD and L72.3 is not covered. The CPT index directly refers you to 10060 for I&D sebaceous cyst. The LCD doesn’t even have unspecified cyst on the list and my provider does not feel abscess or cellulitis is appropriate. Has anyone else come across this?
Thanks,
Crystal