I’m having a hard time trying to find information about which insurances will only pay for the evaluation code for the patient’s first visit with physical therapy. Does anyone know what the insurances are or where I can find that information? Thank you!
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Tag Archives: Insurances
Billing with primary and secondary insurances
Looking to verify the proper patient responsibility to bill them in the following scenario as well as the proper rationale.
Primary insurance is a high deductible plan through BCBS and allows $ 3000.00 to the patient’s deductible for a patient’s surgery on the $ 5000.00 billed charges. We do not participate with the primary insurance. It’s a PPO plan. They were covered by the out of network benefits on the plan. BCBS says the patient’s responsibility is the $ 5000.00.
Secondary insurance is Medicare and we do participate. Medicare allows $ 1000.00, pays out $ 800 with $ 200 coinsurance. Patient responsibility on remit says $ 200.00.
Do you bill the patient only the 20% coinsurance for $ 200?
Or do you bill the patient for $ 4200.00 ($ 5000.00 minus $ 800.00 paid by Medicare)
insurances not updated with the new biopsy codes
So almost all insurance companies except for MEDICARE seems to not have updated their systems to accept the new biopsy codes…
Do we continue to use 11100 and 11101 or wait it out?
Do we have to bill both insurances?
One of our patients recently got a new insurance – so now he has Blue Cross (plus his old ins UHC). He has told us that he just wants us to bill Blue Cross and forget about UHC. Now we have an active contract with both insurances, and his UHC ins is still showing as active. Would there be any issues with JUST billing Blue Cross because he specifically told us not to bill UHC?
Refresh Your Understanding of Basic Health Insurances
Better equip yourself to answer patient questions and secure patient cost-sharing. Nothing stays the same for long in this industry, so even if you are a seasoned healthcare business professional, you may not know all types of insurances and plans available, and how they work. A quick review will assist you in correctly coding, billing, […]
AAPC Knowledge Center
Eyewear coding for Insurances
I was wondering what resources anyone knows of out there for eyewear coding for routine eyewear. I am looking for a resource that can help me give the office I work for examples of how to code glasses. Until recently they were more self pay, and now with so many patients having vision insurance I am trying to show them how to code what the patient is actually getting. Our EHR is not very helpful. Any information would be greatly appreciated.
Question about Coordination of Benefits between Medical and Vision Insurances
Hello,
I am not extremely familiar with filing vision claims and I have tried to research this topic. Most instances it seems that it depends on why the patient is here as to who to bill to as primary, but my question comes in when the patient has a medical insurance and has either a copay, deductible, or coinsurance amount and if vision acts as a secondary to cover these amounts or if the patient is responsible.
The way it has "always been done" here at the clinic I work for is that when the patient’s medical insurance comes back, they file the remainder to any applicable vision policy. I understand that a refraction would be covered in this instance if not covered by the primary, but they have historically changed the diagnoses on the claim for to all vision codes and taken off all the medical. To me this seems incorrect. If the vision insurance acts as a true secondary on medical, then we should be filing the claim exactly the way we did to the medical insurance and not change any diagnosis codes. If their exam was billed as medical because their reason for visit was medical, then that should follow the claim form to the vision insurance company.
My co-worker who has been filing these claims stated that she called the vision company and explained my concerns and the vision company apparently told her it didn’t matter what diagnosis was on the claim. As long as they had the primary EOB, they would process the claim. Now I don’t trust what she is saying which is obviously why I am posting my question here.
Thanks in advance for helping me with this.
Amber