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Medicare Advantage Organization denials raise concerns that private insurers are maximizing profits at the expense of patients. Every year, tens of thousands of people enrolled in private Medicare Advantage (MA) plans are denied necessary care that should be covered under the program, federal investigators concluded in a report published on April 27. The Department of […]
The post MA Plans Wrongly Deny Needed Care, Physician Payments appeared first on AAPC Knowledge Center.
The DOJ wants healthcare organizations to have an effective compliance plan.
The post Feds Want to See Compliance Plans in Action appeared first on AAPC Knowledge Center.
Civica Rx announced that 12 new health systems representing 250 hospitals nationwide, have joined the not-for-profit generic drug company as founding members. That brings the number of hospitals that have joined the project designed to make generic drugs more accessible and less expensive to 750. Civica Rx to Solve Supply, Cost Problems Spotty supply and […]
The post Civica Rx Adds 250 Hospitals, Plans 14 Drugs appeared first on AAPC Knowledge Center.
I am being told that a preventive visit is covered, as in 99396 or 99397 but I cannot get claims to scrub with these codes. Just recently I have started getting rejections and / or patients being billed for these visits. Plan states there is a preventive code but they wouldn’t give it to me.
Please help!..Thanks so much
We have a new provider (an MD – not an NP) who is not quite credentialed with all the health plans our practice participates with. When she sees patients who have an insurance she is not credentialed with, I have been directed to bill those claims under another physician at the practice. Is this acceptable? If anyone can provide me with some guidance on this I would appreciate it greatly!!
-Caitlin
According to the Medicare FQHC Policy Manual under the subcategory Description of Non RHC/FQHC Services regarding lab services:
Does this mean that we should be billing for labs on a CMS-1500 under the rendering provider’s NPI instead of on a UB-04 under our FQHC’s NPI since they are not FQHC services, and expect to get separate reimbursement? We have the billing staff insisting that all of our UnitedHealthcare should be billed out on UB-04 forms regardless of the services we are billing for.
Any assistance is greatly appreciated!