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  1. M

    I work for a radiation oncology practice. If a patient is seen within the global period for a...

    I work for a radiation oncology practice. If a patient is seen within the global period for a new problem, can we bill for the new Dx (such as mets. to the bone)? If so, so we need a special modifier? I searched online and can only find scenarios where surgery was performed and the patient came...
  2. M

    Wiki Rendering provider vs. billing provider

    I WAS ADVISED TO BILL UNDER THE OWNER'S NUMBER WITH A Q5 MODIFIER
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    Wiki MARYELLENG

    We do split billing for our inpatient Medicare cancer patients receiving daily radiation treatment. We recently received an SNF denial on the 77014TC. (We billed G6015 and 77014TC) They stated that SNF was not responsible The edit description said CMS designated these radioisotopes as Category...
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    Wiki J1950

    I USED THE FEMALE CODE IN ERROR :mad:
  5. M

    Wiki J1950

    WE ALWAYS WERE REIMBURSED FOR THE LUPRON INJECTION WITH C61. DX. MEDICARE IS NOW DENYING AS NOT MEDICALLY NCESSARY? ANYONE ELSE EXPERIENCING THIS?
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    Wiki MARY ELLEN

    WE HAVE A NEW BILLING CLIENT WHO IS A GENERAL PRACTIONER. I AM UNFAMILIAR WITH BILLING THE SHINGLES VACCINE. I DO NOT SEE IT LISTED ON ANY FEE SCHEDULE (90750) DO WE HAVE TO INCLUDE THE NDC CODE? DO WE HAVE TO SEND THE INVOICE TO GET REIMBURSED? AM I USING AN INCORRECT CODE? ANY HELP WILL BE...
  7. M

    Wiki Denials prevention

    Hi , hope you are up to the task, Here is one job description: The RN Denial Prevention Specialist will receive daily work assignment from the Team Lead and/or manager to work adjunctively with the Denial Prevention Team to meet deadlines and productivity goals. This RN Denial Prevention...
  8. M

    Wiki Resubmitting Claims

    I only submit the code that was denied. If you are correcting the claim, use the original claim number and resubmission code 6 or c. We always send the deductible to the secondary ins. For payment. If you drop it directly to the patient, they always call and request it anyway. Some plans pay...
  9. M

    Wiki E/m code with procedure

    We used the 25 mod. As we always were paid with that in the past. Should we be using another mod? Thanks for your help. I am new to this
  10. M

    Wiki E/m code with procedure

    We have started getting denials when we have an e/m code with radiation set up codes (77263, 77290, 77334) we always were able to distinguish with a 25 mod. But are consistantly getting denials lately. What has changed?
  11. M

    Wiki mips incentive

    Never mind, got my answer
  12. M

    Wiki mips incentive

    Does anyone know when we will be getting the mips incentive. I see that it is n807 on the medicare grp/rc amt codes but ours has not come thru yet?
  13. M

    Wiki Same day, billing office visit and procedure on separate claims.

    Medicare denied a 99214 mod. 25 with 77263/77334/77290. when we called they informed us we had to use an unbundling code but not modifier 25. We always got paid in the past with the 25 modifier. I cant find anything new on Medicare website.
  14. M

    Wiki Visit with set up codes

    We recently received mcr denial for 99214 (25 mod) which was billed with 77263/77290/77334. We were always paid in the past with a 25 mod on the e & m service. Call to medicare said we have to use "unbundling code" not modifier 25. Help please
  15. M

    Wiki Inpatient consult vs new [atient office visit

    Dr. Saw patient as inpatient consukt. Pt released from hospital and saw dr. In office. Can new patient code be used for subsequent office visit?
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