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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

96127 Tricare denials

Hello we are billing Tricare South for 96127 with modifier 59 and 2 units. These are being denied stating: Billed Procedure Code(S) Pairs Found To Be Unbundled Per Cms Ncc
I can’t find any information on this. Triwest/Vets choice paid with no issues.
I did read that some payers will only pay 1 unit. Also that a 59 modifier is needed.
Anyone have any experience on this with Tricare?

Medical Billing and Coding Forum

Tricare

I need some help and opinions please. I had a new patient in today that had Tricare Select. The Tricare was still showing active. On her demographic sheet, she put single and also listed a "boyfriend". The Tricare sponsor was different than her "boyfriend". The sponsor was her ex husband. The patient did not have her Tricare ID. I called Tricare to verify coverage and she was active, I did tell them all this info. He suggested contacting the sponsor. I did ask the patient if I could contact the sponsor because I was having "trouble verifying her eligibility". Patient said she was not allowed to have contact with him, but due to the situation he had to keep her on his Tricare. She said she just needed to go back to the base to get a new Tricare ID card. To me there are many red flags here. (the reason I a very weary is due to Tricare just recently coming back and taking back over 2 years of claims that they had paid for a patient that had gotten a divorce and Tricare had been contacted many times and for whatever reason Tricare just did not cancel the insurance and continued to pay claims. The patient made us aware of the cancellation when it was termed, it was over 500.00 refunded to Tricare)

Once divorced, doesn’t the spouse have to have their own policy under their own social/ID?

Please give me your thoughts on this.

Thanks!

Medical Billing and Coding Forum

Reimbursement for Orthognathic surgery from Tricare

Normally we bill dentally for most of our dental procedures. There are the few medical but set fee schedules help determine the over all out of pocket cost for patients. In billing medical for Orthognathic surgery, mainly Tricare, if we have the authorization/approval letter, how do I bill out for the procedure and know it will cover costs even though the fee schedule used for reimbursement for code 21189 is considerably less then what the zip code fee book states as appropriate fees for our area? I know Tricare will only cover $ 2,500. I have approvals for codes 41899, 00170 and 21085. I’m just trying to wrap my head around the main CPT code not covering hardly any costs.

Any input in MUCH appreciated!

:confused:

Medical Billing and Coding Forum

Help with billing Anthem and Tricare S9494

I’m hoping someone has an idea what we can do to override a problem we are having between Anthem BCBS and Tricare for Life. We are an infectious disease clinic and many of our patients opt to infuse themselves at home rather than come to the clinic daily. We are not involving a home health agency and provide the patient with all supplies and medications. Anthem requires we bill S9494 with POS 12, however CMS does not allow coverage for this code, therefore Tricare rejects it. Is there any way around this problem, or are we going to have to write off a large sum?

We have since learned from the patient’s account that anytime a federal payer is involved the patient has no choice but to have their infusions in the office due to Anthem’s billing requirements. We are just hoping we may get our original patient paid.

Any help is appreciated, thank you!
Meg W.
Billing Specialist
Infectious Disease Specialists, PC

Medical Billing and Coding Forum

TriCare denies 99402 Clinical Preventive Services

Our office was denied payment for 99402 for a TriCare patient. Denial was that this is a non-covered service but the most current update of the TriCare Manual 6010.60-M section 2.1 and 2.2 state clinical preventive services are covered with no cost sharing and 99402 is listed as an allowable code.
Any ideas? Thoughts?
Thank you,
Marcia Cox

Medical Billing and Coding Forum

Mississippi Physician Convicted in $3 Million TRICARE Pharmacy Fraud

A federal jury found a 78-year-old Biloxi, Mississippi physician guilty for his role in a $ 3 million pharmacy fraud scheme, which included military healthcare funds. According to the Department of Justice (DOJ) press release on March 5, the 78-year-old physician, Albert Diaz, was convicted of: One count of conspiracy to commit healthcare fraud; Four counts of distributing […]
AAPC Knowledge Center

Tricare Address Needed

Hello Everyone,
Our office has a lot of Tricare patients. (West Region) As of 01/01/2018 UnitedHealthCare no longer processes claims for Tricare. Healthnet took Tricare over. I have searched the internet for the new claims address with no luck. I have tried to call them since the first of the year and get nothing but busy signals.
Can someone please let me know what the new claims address is for the West Region? And payer ID?
Thank you!!!

Medical Billing and Coding Forum

Incident to Medicare Part C and TriCare

Does anyone know how to obtain documentation to show Medicare Part C does NOT apply incident to guidelines? It shows Part B follows incident to, but could not find anything about Part C. Also if anyone has clarity if TriCare follows incident to or not. I could not find documentation for TriCare that says yes or no to follow incident to guidelines. Thank you for any help!

Medical Billing and Coding Forum