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    Wiki Covid Vaccine

    BCBS is paying for the vaccine (but far less than our cost) however they are applying the admin fee to patient deduct. We are in discussions with them right now to see if this can be remedied.
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    Wiki 69209 and 69210 Modifier 50 or LT RT

    Some insurance do not cover 69209 - they do consider it inclusive of primary procedure. We use mod 50 for bilateral and have not had issue getting processed.
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    Wiki 87811 COVID 19 Rapid test

    We have issues with UHC denying claims through our clearinghouse but the claims seem to process through when I enter them via UHC web portal. Not sure why.
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    Wiki Growing PT practice needs billing help...

    I would not bill your new PT's under the established PT. I would get the new ones credentialed with your various insurance companies asap. Some ins will backdate the certification or acceptance date of the provider contract while others will not. It can be a maddening process waiting for all...
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    Wiki Request for Repayment Letter

    We just send the patient a statement for the amount due with a note indicating the insurance sent payment directly to them.
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    Wiki Deductibles and Collections

    Is the patient complaining about the amount owed, being sent to collections, or some other reason? If a patient contacts us within a reasonable time frame (maybe a month or two) and indicates there is a financial hardship or other extenuating circumstance as to why they cannot pay the bill- we...
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    Wiki Can NP work independently?

    Check with your state Medical licensing board. They will have specific info whether the NP needs MD supervision.
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    Wiki Download Brandi's Fillable Audit Tool for Excel!

    This looks great! Thanks Brandi-
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    Wiki PT/OT re-evals

    Re-evals 97002 and 97004 are considered bundled into other treatment given on same day. You can add mod 59 to the re-eval code and get paid, but be sure that your re-eval is well documented in your notes and isn;'t just 'lumped' into the normal tx for the day. Refer to current NCCI edits for...
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    Wiki new billing/coding business

    I would strongly suggest you NOT use Office Ally! The old saying " you get wht you pay for" definately holds true with this software. It might be inexpensive in upfront cost but it will cost you money in lack of reports and having to manually construct data that isn't totaled in the few reports...
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    Wiki second ppd

    I believe that if it is outside when the test should have been read then yes, you are allowed to bill for a second test. The patient's insurance may not cover it (if the first was even going to be covered) so you might want to have the patient sign an ABN if you haven't already placed it.
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    Wiki Untimed therapy codes

    I am fairly new to coding for physical therapy; I understand that code 97012 is an untimed code and generally would only be billed with one unit- however if the traction is performed on two different body parts would that qualify for coverage of the second one (using a modifier to cover the...
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    Wiki Help with Medicare denial please?

    Since the 11642 is column two in the mutually exclusive edits, wouldn't that procedure need the 59 mod and the 17000 codes should not need the mod?
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    Wiki Medisoft v17/5010 compliant upgrade?

    We just recently upgraded to version 17 in Medisoft and have had no big issues with the upgrade itself.. The upgrade went very smoothly. We did encounter an issue between Windows 7 security and version 17 though. What we think happened was that the Windows security did not recognize some of...
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    Wiki Provider/Billing question

    I would not bill under another provider-- that is considered to be fraud. If this particular provider is not 'set up' with the insurance companies then she would be considered out of network until she is contracted with the insurance companies.
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    Wiki Intramuscular injection w/ E&M

    Why wouldn't you use 96372 for the injection code vs 20552 which is a trigger point injection?
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    Wiki Procedure code 17000

    I would check your state's LCD on code 17000. If your dx is on the 'covered code' list then I would contact MCR and ask for explanation of denial.
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    Wiki PT/OT coding

    I am trying to find something in writing that indicates if the 'rule of 8' for timed procedure codes would apply to Medicare/Medicaid ONLY vs other carriers. Also- how many of you follow the rule of 8 vs not? Thanks for your help.
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