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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

Humana denials

We are having a problem getting Humana to pay for E/M exams with CMT. Anyone else having this problem?

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

Medical Billing and Coding Forum

Billing 99213, 11721 & 11055 Humana

I am having a hard time getting the any office visit code (99212, 99213, 99214) 11721 & 11055 all paid by Humana. I have always had trouble with this insurance bundling these services and only paying for the lower dollar amount item (this example 11055 was the only one paid). This is how I billed the original claim to Humana:

99213 25 Modifier M20.5X2, M21.6X9, E11.40, M20.41
11721 59, Q9 Modifiers E11.40, I73.9, M79.675, M79.674
11055 LT, 59 Modifiers L85.1, M79.675, E11.40

What am I doing wrong? 2018 I only had a few problems with Humana bundling the codes, this year its all up in the air. Please help me so I can get my provider paid. Thank you in advance! :)

Medical Billing and Coding Forum

Medicare Advantage Plan (Humana)

Humana has been denying our Electrocardiogram, routine ECG with at least 12-leads; interpretation and report only; 93010. Our ER physicians bill this procedure code and Humana has been denying them stating the procedure code is incorrect/or invalid. Of course, I have call Humana and they only say I need to send in the ER notes. Then I found out from coding/editing at Humana that they feel as if the ER physicians abuse this CPT code this is why they want the ER notes. Does anyone know where I can locate the Medicare guidelines for this CPT code? Medicare does pay for this procedure. Or if anyone knows where I can find Humana’s policy about this CPT code it would be greatly appreciated.

Medical Billing and Coding Forum

Therapy Billing Humana

Hello All!
Would anyone help me billing therapy services for humana. They want to recoup the payment for 97110 and 97530 because they were billed together with 92526. Its the first time that we are seeing anything like this, had been billing these codes for a while and had been getting payments even with medicare, would deeply appreciate if somebody has any idea about the combination of these codes.

Thank you

Medical Billing and Coding Forum

Code H0018 denial from Humana

Hello, I work for a billing company here in California and I recently got a denial from Humana stating that we can’t bill code H0018, because we are not a state Medicaid agency. This is first time receiving a denial like this. I have no problem with all the other insurance companies. Has anyone out there received this denial and if so is there another code that you billed instead of the H0018?

Mercy

Medical Billing and Coding Forum