Aetna, bruised by a PHI breach where letters detailing a lawsuit settlement were sent to HIV-positive members revealing their status, is now suing the plaintiffs in the original 2014 class action lawsuit for $ 20 million, blaming a consumer advocacy group and law firm for their woes. Aetna demands $ 20 million and indemnification from any actions related to the breach. […]
AAPC Knowledge Center
Click here for more sample CPC practice exam questions with Full Rationale Answers
Health Leaders Media
Health Leaders Media
Health Leaders Media
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
Tag Archives: Payer
ACP secondary payer issue 99497, 99498
We are having an issue when billing our ACP visits with 99497, 99498. CMS is paying, but the secondary insurer is applying a co-pay of 20-45$ on the ACP claim. When asked CMS they said they have no influence on secondary payers so we are just trying to figure out what we need to do in this case?
thanks in advance for the help!
Payer, Providers to Launch Population Health Engine in NH
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Billing a Bundled CMS Code to Private Payer under Contract
My question is: is it appropriate to enter into individual contracts with private payers for eConsults and to not bill all payers across the board (and ultimately the patients for a service that is not payable by CMS), because it is bundled?
Has anyone entered into a contract with private payors for to pay for eConsults (99446-99449)? The codes are Status Indicator B (bundled Medicare) for which no separate payment is made. As Medicare never reimburses for them, there is no need to issue an ABN or bill to Medicare with a GA modifier. The last Phys Fee discussion I could find in the Federal Register was for CY2016 where comments had been collected, encouraging CMS to pay for the services. In review of the Fee Schedules, the 2014 Fee Schedule did not value the codes with wRVUs; whereas the 2018 fee schedule values the codes. As with CPT 99091, it appears that CMS is moving towards reimbursing for these codes – but not just yet.
The benefits to a payer in paying for a physician to physician eConsult are obvious: lower costs for the contracted payer as the primary care physician does not refer to specialty care, while it assists in maintaining access for higher acuity patients to specialty care. In addition, timely advice to a primary care provider potentially decreases the exacerbation of a condition with resulting higher costs – to the payer. As this code is never reimbursed by Medicare, we should not be obligated to charge other patients whose insurances do not cover these services. It was mentioned in the Federal Register that there should be no liability to the patient because "beneficiaries could be responsible for coinsurance for services of physicians whose role in the beneficiary’s care is not necessarily understood by the beneficiary."
https://www.federalregister.gov/docu…ther-revisions
Thanks!
Carol Yarbrough, MBA, CPC, CHC, CCA, OCS
UCSF Medical Center
Secondary Payer and NPP
Curious as to how others handle this situation:
Primary Insurance, Medicare, claim is submitted under NPP. Secondary payer does not credential NPPs and Payer denies claim. How do you file the claim to get it paid?
Thanks in advance for any help.
Top 4 Payer Priorities for 2016
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Billing a non covered service to secondary payer
If a patient has Medicare and Medicaid, can a preventive exam (9938x-9939x) be performed and billed to Medicaid without billing to Medicare first since it is a non covered service by Medicare?
Medicaid as a secondary payer to Medicare
I have received a lot of denials for CO-207 for my Medicaid secondary’s to Medicare. 207= National Provider Identifier- Invalid Format. I was originally told it was because our referring Dr was incorrect. I have fixed this and still am getting the same denial. Has anyone else experienced this? Any help would be appreciated. Thank you.
-Ali
Single Payer insurance
If the U.S. changes to a single payer/Medicare for all type of system, what will the effect be on billing and coding? I would think it would eliminate a lot of our jobs. If everyone has the same insurance with the same rules, I would think billing and coding would be a lot more straightforward, with few if any variations. not trying to get political, just curious.
John Methgen, BS, CPC-A, CPB
Top 4 Payer Priorities for 2016
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
