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  1. R

    Wiki Billing PPS Codes to Insurance

    It's unbelievable to me that so many insurances don't understand how to process these codes.
  2. R

    Wiki Revenue code for 10040

    Anyone?
  3. R

    Wiki Billing PPS Codes to Insurance

    Lately I cannot get Blue Shield to reprocess any of their claims. I've called Blue Shield probably dozens of times and sent appeals, with no success. Does anyone know if there's a way I can report Blue Shield to some kind of watchdog organization for non-compliance with CMS regulations?
  4. R

    Wiki Billing PPS Codes to Insurance

    So there are no FQHCs here having this problem??
  5. R

    Wiki Billing Two Visits From Same Date to Medicare (FQHC)

    According to this, https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1039.pdf , we are supposed to put modifier 59s on E/M codes when there are multiple E/M codes for the same date of service.
  6. R

    Wiki Billing PPS Codes to Insurance

    This is where I get all my information regarding the PPS rate. https://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC-Center.html The PPS rate doesn't depend on diagnoses, they correspond to different types of E/M codes. So, whatever diagnoses are covered for your EM...
  7. R

    Wiki Billing Two Visits From Same Date to Medicare (FQHC)

    Like I said, every single time I've tried doing this in the past, the second claim has rejected as a duplicate. I've tried billing with modifier 59, modifier XE, condition code G0, and nothing works.
  8. R

    Wiki Billing Two Visits From Same Date to Medicare (FQHC)

    Yes, it doesn't work.
  9. R

    Wiki Billing Two Visits From Same Date to Medicare (FQHC)

    I've done that, but we don't receive any additional money, we receive one payment for both encounters. The end result is exactly the same as Medicare paying for one encounter and denying the other. There is no difference in terms of actual dollars received. We are an FQHC, not a hospital. We...
  10. R

    Wiki Billing Two Visits From Same Date to Medicare (FQHC)

    How do you do that? Every time I bill one claim for medical services and another for mental health, one gets paid and the other gets rejected as a duplicate. I've tried modifier 59, condition code G0, modifier XE, and nothing works.
  11. R

    Wiki Billing PPS Codes to Insurance

    Anyone?
  12. R

    Wiki Billing Two Visits From Same Date to Medicare (FQHC)

    I don't think we can use that modifier since we are not a hospital. According to this link: http://www.codingahead.com/2011/10/modifier-27-usage-and-reimbursement.html , "This modifier is not to be used by physician practices. It was created exclusively for hospital outpatient departments...
  13. R

    Wiki Billing Two Visits From Same Date to Medicare (FQHC)

    Even though the Medicare manual explicitly says that we can?
  14. R

    Wiki Billing Two Visits From Same Date to Medicare (FQHC)

    If the patient is seen twice by two different physicians at the same FQHC, and we are billing two facility claims, does that still count as two different providers?
  15. R

    Wiki Billing Two Visits From Same Date to Medicare (FQHC)

    Yes, I have referred to that section in the past. I posted the link to the MLN article that covers the exact same subject, using modifier 59 to bill multiple visits. This has never worked, Medicare doesn't seem like they understand their own policies.
  16. R

    Wiki Billing Two Visits From Same Date to Medicare (FQHC)

    It's a facility claim on a UB-04.
  17. R

    Wiki Billing PPS Codes to Insurance

    I work for an FQHC and we're required to put a PPS code on each claim. However, if we try billing these codes to private insurances (Blue Cross, Aetna, etc) they always deny the claims, stating that they aren't valid codes. This creates a problem when we have to bill a private insurance...
  18. R

    Wiki Billing Two Visits From Same Date to Medicare (FQHC)

    I work for an FQHC and we've never been able to get Medicare to send two payments for the same date of service for the same patient. We're not trying to double dip, it's just that some of our patients will sometimes see two different providers at our clinic on the same day (vision/medical, or...
  19. R

    Wiki Revenue code for 10040

    Does anyone know what revenue code an FQHC should use for CPT code 10040 (acne surgery)? I called my MAC for help and they just said they couldn't tell me how to bill.
  20. R

    Wiki FQHC MC Billing

    How are FQHCs supposed to bill secondary insurances after Medicare pays? We're getting a lot of denials because the insurance companies don't seem to understand the PPS system, and they are claiming the PPS codes aren't covered services.
  21. R

    Wiki Denial Billing secondary with G code.

    smieloch, you list the G0467 with the appropriate revenue code and no dollar amount? To clarify the original post (we work in the same office) we're an FQHC and we are required to put a PPS rate code on the claim (G0467, G0466, etc) along with the E/M code. I don't think we'd be able to list a...
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