Laureen shows you her proprietary “Bubbling and Highlighting Technique”
Download your Free copy of my "Medical Coding From Home Ebook" at the top right corner of this page
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.
New patient evaluation and management (E/M) claims are being denied when the patient was previously seen by a specialty physician assistant or specialty nurse practitioner on staff. This is happening when another provider of a different specialty in the same multi-specialty group sees the patient for the first time and bills a new patient E/M […]
The post New Patient E/M Denials: Mystery Solved appeared first on AAPC Knowledge Center.
Medicare has been issuing beneficiaries new member cards with Medicare Beneficiary Identifiers (MBI) in place of Social Security Numbers (SSNs) for more than two years. 2019 was a phase-in period when Medicare would accept either a beneficiary’s Social Security Number or their new MBI on claims. Starting Jan. 1, 2020, CMS will reject any Medicare […]
The post Prevent Medicare Claims Denials in 2020 appeared first on AAPC Knowledge Center.
Collection and interpretation of the remotely captured data only (without treatment or management) is reported with CPT code 99091
For RPM treatment and management services, use CPT code 99457
RPM limitations:
Additional points of consideration:
For More Information: Click Here
First denial is almost always incorrect (ie. denying new patient exam when the patient is new or hasn’t been seen in over 3 years) We include documentation and a paragraph on why the doctor sees medical necessity for an exam. The second denial is just based on medical necessity and then we get a massive request for notes on past and current treatment. We don’t see anything in our contract about bundling E/M with CMTs like United Health Care does.
We don’t have many Humana commercial patients, but this is getting so annoying that we may consider dropping out of Humana network.
Any ideas would be appreciated!
pattiland
Thank you!
This is my first time posting, so I hope I’m in the right forum and also not repeating someone else’s question.
This question is specifically for Aetna in Texas but any feedback is appreciated.
I am getting no where fast when trying to get reimbursement from Aetna for Televisits. I’ve coded it all kinds of ways: POS 2 no modifiers, POS 2 modifier GT, and POS 2 modifier 95.
Every claim is being denied for various reasons: (1) Missing/incomplete/invalid/inappropriate place of service, (2) Procedure code incidental to primary procedure, and/or (3) Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. (and a few other denials… basically all meaning the same thing)
What makes it worse is that every Aetna provider rep I get on the phone tells me something different. A lot of overseas reps will just default to "appeal and send records," but I cannot do that for EVERY Aetna televisit! Does anyone know what Aetna’s deal is? What is the best way to bill televisits for Aetna members?
Thank you in advance for your input!
-Brennen