Thank you sooooo much for the fast responses to my question.
I checked out the links and it helped a lot.  Thank you again!!!
Sandy

Hello,
 
Can anyone please send me a link as to how Cobra operates.  I know it's an
extension of coverage when a person quits or gets laid off of their job.  What
is the process from a billers point of view?  The medical biller in the office
is out today so I don't have her to ask.
 
Thanks!,
 
Carol




[Non-text portions of this message have been removed]

THEY TAKE FOREVER TO PAY! I HATE DEALING WITH THEM... YOU WILL GET ATLEAST 2
DENIALS STATING THE MEMBER IS NOT FOUND. THEN THEY WILL PAY AFTER A FEW PHONE
CALLS.. AT LEAST THATS HOW IT IS HERE. GOOD LUCK!

TINA C.



--- In MedicalBillers@yahoogroups.com, Carol Roush <carollroush@...> wrote:
>
> Hello,
>  
> Can anyone please send me a link as to how Cobra operates.  I know it's an
extension of coverage when a person quits or gets laid off of their job.  What
is the process from a billers point of view?  The medical biller in the office
is out today so I don't have her to ask.
>  
> Thanks!,
>  
> Carol
>
>
>
>
> [Non-text portions of this message have been removed]
>

Here's a couple of web pages Carol...hope this helps.  You can also pull your
insurance contracts and read the COBRA section...usually it's in most benefits
books though.

http://www.dol.gov/dol/topic/health-plans/cobra.htm

http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.HTML

Melinda Brown, CMBS
Ins Biller

--- In MedicalBillers@yahoogroups.com, Carol Roush <carollroush@...> wrote:
>
> Hello,
>  
> Can anyone please send me a link as to how Cobra operates.  I know it's an
extension of coverage when a person quits or gets laid off of their job.  What
is the process from a billers point of view?  The medical biller in the office
is out today so I don't have her to ask.
>  
> Thanks!,
>  
> Carol
>
>
>
>
> [Non-text portions of this message have been removed]
>

COBRA is not "A" plan, it's an extension of an existing plan. The reason you
get denials is because the employer forwards the premiums and coverage is
based on WHEN they get the premium payment. Underwriting will put in a
termination date if the premium is not in on the due date. With group plans
there are extensions and grace periods, when a member is terminated the
carrier has to re-load all the information into a new database and the
termination date will stay until the premium is paid (No extensions or grace
period) Many times a member will opt for COBRA and then find new employment,
or they just don't make the premium, and that results in a term date and the
carrier will then kick out the claim as "After termination" or "Not found"
if it's a new Cobra case.



Linda Walker

Practice Managers Resource & Networking Community
  <http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
  <http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry



From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
On Behalf Of tcatherman.apeds
Sent: Wednesday, May 06, 2009 11:02 AM
To: MedicalBillers@yahoogroups.com
Subject: [MedicalBillers] Re: Cobra








THEY TAKE FOREVER TO PAY! I HATE DEALING WITH THEM... YOU WILL GET ATLEAST 2
DENIALS STATING THE MEMBER IS NOT FOUND. THEN THEY WILL PAY AFTER A FEW
PHONE CALLS.. AT LEAST THATS HOW IT IS HERE. GOOD LUCK!

TINA C.

--- In MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com> , Carol Roush <carollroush@...>
wrote:
>
> Hello,
>
> Can anyone please send me a link as to how Cobra operates.  I know it's an
extension of coverage when a person quits or gets laid off of their job.
What is the process from a billers point of view?  The medical biller in the
office is out today so I don't have her to ask.
>
> Thanks!,
>
> Carol
>
>
>
>
> [Non-text portions of this message have been removed]
>





__________ Information from ESET Smart Security, version of virus signature
database 4055 (20090506) __________

The message was checked by ESET Smart Security.

http://www.eset.com



[Non-text portions of this message have been removed]

Since i am just starting out as a ins. biller, does anybody know how to get your
money from insurance companies and or attorneys regarding WC and PI claims?

What is the best procedure?  Does anybody have any tips?  Shortcuts?  really
good ways?

What are the best questions to ask when calling the attorneys?

If anyone can help i would be really greatful.

Thank you

Hi Christina, I actually have the same questions.  I just started doing some
work for some doctors who I offered to do their medical claims and they
asked me to also do their WC and No-fault.  I don't have a clue on any of
them.  All I know is that, since January 1, 2009, worker's compensation in
NYS implemented the use of forms for Initial, follow-ups, narrative, etc.
Everything is with their forms now.  In fact, you can also do them online
but the doctor has to be participating already.

On Tue, May 12, 2009 at 10:20 PM, christina <chrstna1519@...> wrote:

>
>
> Since i am just starting out as a ins. biller, does anybody know how to get
> your money from insurance companies and or attorneys regarding WC and PI
> claims?
>
> What is the best procedure? Does anybody have any tips? Shortcuts? really
> good ways?
>
> What are the best questions to ask when calling the attorneys?
>
> If anyone can help i would be really greatful.
>
> Thank you
>
>
>



--
Josie Mapp
JG Professional Services, Inc.
Credentialing, Collections & Medical Billing Services
Cell: 917-892-7201
Fax: 646-403-3699

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[Non-text portions of this message have been removed]

There are no shortcuts when dealing with PI and WC, if you get a client or a
provider that does a lot of these, they will spend most time "waiting". You
should always try and obtain a letter of protection (LOP) when an attorney
is involved which will help when the case is resolved, but many of these
cases just take time and it depends on how backed up each state is.



Linda Walker

Practice Managers Resource & Networking Community
  <http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
  <http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry



From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
On Behalf Of christina
Sent: Tuesday, May 12, 2009 10:21 PM
To: MedicalBillers@yahoogroups.com
Subject: [MedicalBillers] WC and PI claims








Since i am just starting out as a ins. biller, does anybody know how to get
your money from insurance companies and or attorneys regarding WC and PI
claims?

What is the best procedure? Does anybody have any tips? Shortcuts? really
good ways?

What are the best questions to ask when calling the attorneys?

If anyone can help i would be really greatful.

Thank you





__________ Information from ESET Smart Security, version of virus signature
database 4072 (20090513) __________

The message was checked by ESET Smart Security.

http://www.eset.com



[Non-text portions of this message have been removed]

Who do we obtain the letter of proteccion from?

On May 14, 2009 7:22 AM, "Linda Walker" <linda@...> wrote:



There are no shortcuts when dealing with PI and WC, if you get a client or a
provider that does a lot of these, they will spend most time "waiting". You
should always try and obtain a letter of protection (LOP) when an attorney
is involved which will help when the case is resolved, but many of these
cases just take time and it depends on how backed up each state is.

Linda Walker

Practice Managers Resource & Networking Community
<http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
<http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry

From: MedicalBillers@yahoogroups.com <MedicalBillers%40yahoogroups.com>[mailto:
MedicalBillers@yahoogroups.com <MedicalBillers%40yahoogroups.com>]
On Behalf Of christina
Sent: Tuesday, May 12, 2009 10:21 PM
To: MedicalBillers@yahoogroups.com <MedicalBillers%40yahoogroups.com>
Subject: [MedicalBillers] WC and PI claims

Since i am just starting out as a ins. biller, does anybody know how to get
your money from insura...
__________ Information from ESET Smart Security, version of virus signature
database 4072 (20090513) __________

The message was checked by ESET Smart Security.

http://www.eset.com

[Non-text portions of this message have been removed]




[Non-text portions of this message have been removed]

It's what you get from the patient's attorney that basically promises
payment direct from them once the case has settled.



Linda Walker

Practice Managers Resource & Networking Community
  <http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
  <http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry



From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
On Behalf Of Josie Mapp
Sent: Thursday, May 14, 2009 8:37 AM
To: MedicalBillers@yahoogroups.com
Subject: Re: RE: [MedicalBillers] WC and PI claims








Who do we obtain the letter of proteccion from?

On May 14, 2009 7:22 AM, "Linda Walker" <linda@...
<mailto:linda%40billerswebsite.com> > wrote:

There are no shortcuts when dealing with PI and WC, if you get a client or a
provider that does a lot of these, they will spend most time "waiting". You
should always try and obtain a letter of protection (LOP) when an attorney
is involved which will help when the case is resolved, but many of these
cases just take time and it depends on how backed up each state is.

Linda Walker

Practice Managers Resource & Networking Community
<http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
<http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry

From: MedicalBillers@yahoogroups.com
<mailto:MedicalBillers%40yahoogroups.com>
<MedicalBillers%40yahoogroups.com>[mailto:
MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>
<MedicalBillers%40yahoogroups.com>]
On Behalf Of christina
Sent: Tuesday, May 12, 2009 10:21 PM
To: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>
<MedicalBillers%40yahoogroups.com>
Subject: [MedicalBillers] WC and PI claims

Since i am just starting out as a ins. biller, does anybody know how to get
your money from insura...
__________ Information from ESET Smart Security, version of virus signature
database 4072 (20090513) __________

The message was checked by ESET Smart Security.

http://www.eset.com

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]





__________ Information from ESET Smart Security, version of virus signature
database 4074 (20090514) __________

The message was checked by ESET Smart Security.

http://www.eset.com



[Non-text portions of this message have been removed]

What state are you in?  Most states have a Workers Comp rule book for claims.
With time lines on how long a carrier has to pay you.  If it is at the attorneys
level make sure your claims are listed in his settlement and get paid from the
attorney.  If you dont the patient will get the money and good luck collecting. 
 
Be sure to check if your state allows a penalty increase for the WC carrier not
acknowledging your claim within the allowed time.  In Michigan its 3% of the fee
schedule if the carrier does not acknowledge your clean claim within 30 days. 

--- On Tue, 5/12/09, christina <chrstna1519@...> wrote:

From: christina <chrstna1519@...>
Subject: [MedicalBillers] WC and PI claims
To: MedicalBillers@yahoogroups.com
Date: Tuesday, May 12, 2009, 10:20 PM








Since i am just starting out as a ins. biller, does anybody know how to get your
money from insurance companies and or attorneys regarding WC and PI claims?

What is the best procedure? Does anybody have any tips? Shortcuts? really good
ways?

What are the best questions to ask when calling the attorneys?

If anyone can help i would be really greatful.

Thank you
















[Non-text portions of this message have been removed]

Ny

On May 14, 2009 3:25 PM, "debbie brosnan" <thebiller_2000@...> wrote:



What state are you in?  Most states have a Workers Comp rule book for
claims. With time lines on how long a carrier has to pay you.  If it is at
the attorneys level make sure your claims are listed in his settlement and
get paid from the attorney.  If you dont the patient will get the money and
good luck collecting.

Be sure to check if your state allows a penalty increase for the WC carrier
not acknowledging your claim within the allowed time.  In Michigan its 3% of
the fee schedule if the carrier does not acknowledge your clean claim within
30 days.

--- On Tue, 5/12/09, christina <chrstna1519@...<chrstna1519%40yahoo.com>>
wrote:

From: christina <chrstna1519@... <chrstna1519%40yahoo.com>>

Subject: [MedicalBillers] WC and PI claims
To: MedicalBillers@yahoogroups.com <MedicalBillers%40yahoogroups.com>
Date: Tuesday, May 12, 2009, 10:20 PM

Since i am just starting out as a ins. biller, does anybody know how to get
your money from insura...

[Non-text portions of this message have been removed]



[Non-text portions of this message have been removed]

Right, the wording is never a length of time they have to "Pay" a claim,
it's length of time they have to "acknowledge" and/or "respond" to a claim.
Most carriers do by telling you "Hey, we got your claim and it's going to
review!". That's all they have to do. Open WC comp cases can go smoothly if
all the ducks are in a row, it's new claims that usually drag out.



Linda Walker

Practice Managers Resource & Networking Community
  <http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
  <http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry



From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
On Behalf Of debbie brosnan
Sent: Thursday, May 14, 2009 3:22 PM
To: MedicalBillers@yahoogroups.com
Subject: Re: [MedicalBillers] WC and PI claims








What state are you in?  Most states have a Workers Comp rule book for
claims. With time lines on how long a carrier has to pay you.  If it is at
the attorneys level make sure your claims are listed in his settlement and
get paid from the attorney.  If you dont the patient will get the money and
good luck collecting.

Be sure to check if your state allows a penalty increase for the WC carrier
not acknowledging your claim within the allowed time.  In Michigan its 3% of
the fee schedule if the carrier does not acknowledge your clean claim within
30 days.

--- On Tue, 5/12/09, christina <chrstna1519@...
<mailto:chrstna1519%40yahoo.com> > wrote:

From: christina <chrstna1519@... <mailto:chrstna1519%40yahoo.com> >
Subject: [MedicalBillers] WC and PI claims
To: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>

Date: Tuesday, May 12, 2009, 10:20 PM

Since i am just starting out as a ins. biller, does anybody know how to get
your money from insurance companies and or attorneys regarding WC and PI
claims?

What is the best procedure? Does anybody have any tips? Shortcuts? really
good ways?

What are the best questions to ask when calling the attorneys?

If anyone can help i would be really greatful.

Thank you

[Non-text portions of this message have been removed]





__________ Information from ESET Smart Security, version of virus signature
database 4075 (20090514) __________

The message was checked by ESET Smart Security.

http://www.eset.com



[Non-text portions of this message have been removed]

When d we ask for this letter?  Is it at the beginning of the claim?  How do
attorneys usually react when you ask for a letter of protection?  Favorable or
Not happy to get one to you?

--- On Thu, 5/14/09, Linda Walker <linda@...> wrote:


From: Linda Walker <linda@...>
Subject: RE: RE: [MedicalBillers] WC and PI claims
To: MedicalBillers@yahoogroups.com
Date: Thursday, May 14, 2009, 8:43 AM








It's what you get from the patient's attorney that basically promises
payment direct from them once the case has settled.

Linda Walker

Practice Managers Resource & Networking Community
<http://www.billersw ebsite.com> http://www.billersw ebsite.com
A division of K&L Media, LLC
<http://www.klmedial lc.com> http://www.klmedial lc.com

Website Design & Management for the Medical Services Industry

From: MedicalBillers@ yahoogroups. com [mailto:MedicalBillers@ yahoogroups. com]
On Behalf Of Josie Mapp
Sent: Thursday, May 14, 2009 8:37 AM
To: MedicalBillers@ yahoogroups. com
Subject: Re: RE: [MedicalBillers] WC and PI claims

Who do we obtain the letter of proteccion from?

On May 14, 2009 7:22 AM, "Linda Walker" <linda@billerswebsit e.com
<mailto:linda% 40billerswebsite .com> > wrote:

There are no shortcuts when dealing with PI and WC, if you get a client or a
provider that does a lot of these, they will spend most time "waiting". You
should always try and obtain a letter of protection (LOP) when an attorney
is involved which will help when the case is resolved, but many of these
cases just take time and it depends on how backed up each state is.

Linda Walker

Practice Managers Resource & Networking Community
<http://www.billersw ebsite.com> http://www.billersw ebsite.com
A division of K&L Media, LLC
<http://www.klmedial lc.com> http://www.klmedial lc.com

Website Design & Management for the Medical Services Industry

From: MedicalBillers@ yahoogroups. com
<mailto:MedicalBill ers%40yahoogroup s.com>
<MedicalBillers% 40yahoogroups. com>[mailto:
MedicalBillers@ yahoogroups. com <mailto:MedicalBill ers%40yahoogroup s.com>
<MedicalBillers% 40yahoogroups. com>]
On Behalf Of christina
Sent: Tuesday, May 12, 2009 10:21 PM
To: MedicalBillers@ yahoogroups. com <mailto:MedicalBill ers%40yahoogroup s.com>
<MedicalBillers% 40yahoogroups. com>
Subject: [MedicalBillers] WC and PI claims

Since i am just starting out as a ins. biller, does anybody know how to get
your money from insura...
__________ Information from ESET Smart Security, version of virus signature
database 4072 (20090513) __________

The message was checked by ESET Smart Security.

http://www.eset. com

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

__________ Information from ESET Smart Security, version of virus signature
database 4074 (20090514) __________

The message was checked by ESET Smart Security.

http://www.eset. com

[Non-text portions of this message have been removed]



















[Non-text portions of this message have been removed]

Can you elaborate a little more?  What should go first, second, etc.

--- On Thu, 5/14/09, Linda Walker <linda@...> wrote:


From: Linda Walker <linda@...>
Subject: RE: [MedicalBillers] WC and PI claims
To: MedicalBillers@yahoogroups.com
Date: Thursday, May 14, 2009, 5:37 PM








Right, the wording is never a length of time they have to "Pay" a claim,
it's length of time they have to "acknowledge" and/or "respond" to a claim.
Most carriers do by telling you "Hey, we got your claim and it's going to
review!". That's all they have to do. Open WC comp cases can go smoothly if
all the ducks are in a row, it's new claims that usually drag out.

Linda Walker

Practice Managers Resource & Networking Community
<http://www.billersw ebsite.com> http://www.billersw ebsite.com
A division of K&L Media, LLC
<http://www.klmedial lc.com> http://www.klmedial lc.com

Website Design & Management for the Medical Services Industry

From: MedicalBillers@ yahoogroups. com [mailto:MedicalBillers@ yahoogroups. com]
On Behalf Of debbie brosnan
Sent: Thursday, May 14, 2009 3:22 PM
To: MedicalBillers@ yahoogroups. com
Subject: Re: [MedicalBillers] WC and PI claims

What state are you in? Most states have a Workers Comp rule book for
claims. With time lines on how long a carrier has to pay you. If it is at
the attorneys level make sure your claims are listed in his settlement and
get paid from the attorney. If you dont the patient will get the money and
good luck collecting.

Be sure to check if your state allows a penalty increase for the WC carrier
not acknowledging your claim within the allowed time. In Michigan its 3% of
the fee schedule if the carrier does not acknowledge your clean claim within
30 days.

--- On Tue, 5/12/09, christina <chrstna1519@ yahoo.com
<mailto:chrstna1519 %40yahoo. com> > wrote:

From: christina <chrstna1519@ yahoo.com <mailto:chrstna1519 %40yahoo. com> >
Subject: [MedicalBillers] WC and PI claims
To: MedicalBillers@ yahoogroups. com <mailto:MedicalBill ers%40yahoogroup s.com>

Date: Tuesday, May 12, 2009, 10:20 PM

Since i am just starting out as a ins. biller, does anybody know how to get
your money from insurance companies and or attorneys regarding WC and PI
claims?

What is the best procedure? Does anybody have any tips? Shortcuts? really
good ways?

What are the best questions to ask when calling the attorneys?

If anyone can help i would be really greatful.

Thank you

[Non-text portions of this message have been removed]

__________ Information from ESET Smart Security, version of virus signature
database 4075 (20090514) __________

The message was checked by ESET Smart Security.

http://www.eset. com

[Non-text portions of this message have been removed]



















[Non-text portions of this message have been removed]

I always asked for it upon the patient's first visit and once I knew an
attorney was involved. I've never had an attorney refuse one unless the
doctor was getting paid from a settlement.



Linda Walker

Practice Managers Resource & Networking Community
  <http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
  <http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry



From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
On Behalf Of christina
Sent: Thursday, May 14, 2009 10:06 PM
To: MedicalBillers@yahoogroups.com
Subject: RE: RE: [MedicalBillers] WC and PI claims








When d we ask for this letter?  Is it at the beginning of the claim?  How do
attorneys usually react when you ask for a letter of protection?  Favorable
or Not happy to get one to you?

--- On Thu, 5/14/09, Linda Walker <linda@...
<mailto:linda%40billerswebsite.com> > wrote:

From: Linda Walker <linda@...
<mailto:linda%40billerswebsite.com> >
Subject: RE: RE: [MedicalBillers] WC and PI claims
To: MedicalBillers@yahoogroups.com <mailto:MedicalBillers%40yahoogroups.com>

Date: Thursday, May 14, 2009, 8:43 AM

It's what you get from the patient's attorney that basically promises
payment direct from them once the case has settled.

Linda Walker

Practice Managers Resource & Networking Community
<http://www.billersw ebsite.com> http://www.billersw ebsite.com
A division of K&L Media, LLC
<http://www.klmedial lc.com> http://www.klmedial lc.com

Website Design & Management for the Medical Services Industry

From: MedicalBillers@ yahoogroups. com [mailto:MedicalBillers@ yahoogroups.
com]
On Behalf Of Josie Mapp
Sent: Thursday, May 14, 2009 8:37 AM
To: MedicalBillers@ yahoogroups. com
Subject: Re: RE: [MedicalBillers] WC and PI claims

Who do we obtain the letter of proteccion from?

On May 14, 2009 7:22 AM, "Linda Walker" <linda@billerswebsit e.com
<mailto:linda% 40billerswebsite .com> > wrote:

There are no shortcuts when dealing with PI and WC, if you get a client or a
provider that does a lot of these, they will spend most time "waiting". You
should always try and obtain a letter of protection (LOP) when an attorney
is involved which will help when the case is resolved, but many of these
cases just take time and it depends on how backed up each state is.

Linda Walker

Practice Managers Resource & Networking Community
<http://www.billersw ebsite.com> http://www.billersw ebsite.com
A division of K&L Media, LLC
<http://www.klmedial lc.com> http://www.klmedial lc.com

Website Design & Management for the Medical Services Industry

From: MedicalBillers@ yahoogroups. com
<mailto:MedicalBill ers%40yahoogroup s.com>
<MedicalBillers% 40yahoogroups. com>[mailto:
MedicalBillers@ yahoogroups. com <mailto:MedicalBill ers%40yahoogroup s.com>
<MedicalBillers% 40yahoogroups. com>]
On Behalf Of christina
Sent: Tuesday, May 12, 2009 10:21 PM
To: MedicalBillers@ yahoogroups. com <mailto:MedicalBill ers%40yahoogroup
s.com>
<MedicalBillers% 40yahoogroups. com>
Subject: [MedicalBillers] WC and PI claims

Since i am just starting out as a ins. biller, does anybody know how to get
your money from insura...
__________ Information from ESET Smart Security, version of virus signature
database 4072 (20090513) __________

The message was checked by ESET Smart Security.

http://www.eset. com

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

__________ Information from ESET Smart Security, version of virus signature
database 4074 (20090514) __________

The message was checked by ESET Smart Security.

http://www.eset. com

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]





__________ Information from ESET Smart Security, version of virus signature
database 4076 (20090514) __________

The message was checked by ESET Smart Security.

http://www.eset.com



[Non-text portions of this message have been removed]

Hi! I could really use some help. I am a biller for an ASC.Recently we had a
patient scheduled for a colonoscopy. The procedure was started but had to be
stopped because the patient had a colostomy. They had another surgeon come in
and revise the colostomy and then the first surgeon performed the colonsocopy.
The  powers that be want me to bill for the discontinued colonoscpy, the
revision of the colostomy and the completed colonoscopy. I know there is a
modifer for the discontinued procedure but is it proper to bill all 3
procedures? I have 20 years of billing experience but I am definetly not a
coding expert. Any and all opinions are appreciated as I am the only biller for
the surgery center and don;t have anyone to bounce questions off of. Thanking
you in adveance.  EDS

Greetings to all,

Can anyone tell me is it right to bill 99203 along with 99058, does it requires
any modifier or the whole billing is incorrect as per the correct coding
initiative.

I reviewed the old messages in the group reg billing together E&M and ER but,
this kind of combination is not available.

Your feedback will be of great help to me. Thanking in advance.

Regards,
R. J




[Non-text portions of this message have been removed]

We billed both Medicare and Medi-Cal for Flu shots using the
2 CPT codes for the procedure.

Medicare approved, Medi-Cal did not.

Does anyone know what Medi-Cal is looking for?

Thanks in advance.

Are Insulin Injections and Blood Glucose testing covered by Medicare and
Medi-Cal?

If yes, what are the correct CPT codes and modifiers for these? ( We're getting
rejected. )

Thanks in advance for assistance.

Does anybody know the difference between 97112 and 97530?  They are therapeutic
procedures.
 
thanks christina




[Non-text portions of this message have been removed]

Yes. 97112 is neuromuscular re-education of movement, balance,
co-ordination,kinesthetic sense, posture,and prprioception.

And 97130 is therapeutic activities (uses techniques and dynamic activites using
parameters such as balance, strength,range of motion for functional activity not
related to work) transfers, lying to sitting, thowing, catching, swinging,
assembly activities, lifting, etc.
Diana
--- In MedicalBillers@yahoogroups.com, christina <chrstna1519@...> wrote:
>
> Does anybody know the difference between 97112 and 97530?  They are
therapeutic procedures.
>  
> thanks christina
>
>
>
>
> [Non-text portions of this message have been removed]
>

If 99058 is a service on the CCI edit list and is excluded from combining it
with 99203, it may be allowed with the 25 modifier if the requirements of a
seprate service are met and documented.  You may have to send records to prove
that with the claim.  No modifier, no payment if it's on the code set list.
Diana
--- In MedicalBillers@yahoogroups.com, Jagan <jagan_avaunte@...> wrote:
>
> Greetings to all,
>
> Can anyone tell me is it right to bill 99203 along with 99058, does it
requires any modifier or the whole billing is incorrect as per the correct
coding initiative.
>
> I reviewed the old messages in the group reg billing together E&M and ER but,
this kind of combination is not available.
>
> Your feedback will be of great help to me. Thanking in advance.
>
> Regards,
> R. J
>
>
>
>
> [Non-text portions of this message have been removed]
>

Hello,
I'm hoping that maybe some of my fellow medical billers from the Washington DC
area will be able to help me.

I am having a difficult time getting Kaiser Permanente to pay their claims
correctly.  This problem only happens at the Rockville, MD Kaiser location and
all claims that I send to Plano, TX are paid fine.  Basically, Kaiser denies
ever other claim for reasons such as "5th digit of diagnosis missing" which is
simply not true.  I include it on every claim.  Some claims are denied due to no
auth.  Again, authorization number has been included on each claim.  I am at a
loss of what to do.

I talked with them over the phone and sent complaints along with my claim
appeals.  Same problems continue happening.  I'm not sure  how paper claims get
processed once they reach the insurance co., but I get the feeling that either
my claims go to the same "sloppy" data entry person, or Kaiser is simply trying
to hold on to their money as long as possible so that it generates interest for
them before they pay the provider.

At this point, I'd rather do five Medicare claims for one Kaiser claim (have had
no problems with  Medicare!).  I have asked the provider to contact Kaiser and
I'm looking into getting set up to file electronically with them, hoping that
will make a difference.  My provider has a very small mental health practice and
so far electronic billing software has not been cost effective (we use web based
claim filing for most of our other billing).

Any thoughts or suggestions will be much appreciated!

Marta

Hello,
I'm hoping that maybe some of my fellow medical billers from the Washington DC
area will be able to help me.

I am having a difficult time getting Kaiser Permanente to pay their claims
correctly.  This problem only happens at the Rockville, MD Kaiser location and
all claims that I send to Plano, TX are paid fine.  Basically, Kaiser denies
ever other claim for reasons such as "5th digit of diagnosis missing" which is
simply not true.  I include it on every claim.  Some claims are denied due to no
auth.  Again, authorization number has been included on each claim.  I am at a
loss of what to do.

I talked with them over the phone and sent complaints along with my claim
appeals.  Same problems continue happening.  I'm not sure  how paper claims get
processed once they reach the insurance co., but I get the feeling that either
my claims go to the same "sloppy" data entry person, or Kaiser is simply trying
to hold on to their money as long as possible so that it generates interest for
them before they pay the provider.

At this point, I'd rather do five Medicare claims for one Kaiser claim (have had
no problems with  Medicare!).  I have asked the provider to contact Kaiser and
I'm looking into getting set up to file electronically with them, hoping that
will make a difference.  My provider has a very small mental health practice and
so far electronic billing software has not been cost effective (we use web based
claim filing for most of our other billing).

Any thoughts or suggestions will be much appreciated!

Marta

Marta, did you check with your clearinghouse and make sure your codes are
not getting trunucated?



Linda Walker

Practice Managers Resource & Networking Community
  <http://www.billerswebsite.com> http://www.billerswebsite.com
A division of K&L Media, LLC
  <http://www.klmediallc.com> http://www.klmediallc.com

Website Design & Management for the Medical Services Industry



From: MedicalBillers@yahoogroups.com [mailto:MedicalBillers@yahoogroups.com]
On Behalf Of Marta Sanders
Sent: Thursday, May 21, 2009 3:49 PM
To: MedicalBillers@yahoogroups.com
Subject: [MedicalBillers] Problems with Kaiser Permanente Claims








Hello,
I'm hoping that maybe some of my fellow medical billers from the Washington
DC area will be able to help me.

I am having a difficult time getting Kaiser Permanente to pay their claims
correctly. This problem only happens at the Rockville, MD Kaiser location
and all claims that I send to Plano, TX are paid fine. Basically, Kaiser
denies ever other claim for reasons such as "5th digit of diagnosis missing"
which is simply not true. I include it on every claim. Some claims are
denied due to no auth. Again, authorization number has been included on each
claim. I am at a loss of what to do.

I talked with them over the phone and sent complaints along with my claim
appeals. Same problems continue happening. I'm not sure how paper claims get
processed once they reach the insurance co., but I get the feeling that
either my claims go to the same "sloppy" data entry person, or Kaiser is
simply trying to hold on to their money as long as possible so that it
generates interest for them before they pay the provider.

At this point, I'd rather do five Medicare claims for one Kaiser claim (have
had no problems with Medicare!). I have asked the provider to contact Kaiser
and I'm looking into getting set up to file electronically with them, hoping
that will make a difference. My provider has a very small mental health
practice and so far electronic billing software has not been cost effective
(we use web based claim filing for most of our other billing).

Any thoughts or suggestions will be much appreciated!

Marta





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database 4094 (20090521) __________

The message was checked by ESET Smart Security.

http://www.eset.com



[Non-text portions of this message have been removed]

Hi, Linda,
I send paper claims to Kaiser.  It's not the most efficient, but it
works for our small practice (at least it used to work!). I also send
paper claims to Medicare and APS (and even Kaiser in Plano, TX)--no
problems there! All the denials are for the Kaiser billing that has
to go to the Rockville, MD office.

I am thinking of signing up with a clearinghouse that can transmit
to Kaiser, if it's cost-effective.  Most of our other (non-Kaiser)
claims are sent through web-based services that are offered for free
by individual insurance companies (i.e. Payerpath for CareFirst BCBS
claims, etc.). Thank you.

Marta


--- In MedicalBillers@yahoogroups.com, "Linda Walker" <linda@...> wrote:
>
> Marta, did you check with your clearinghouse and make sure your codes are
> not getting trunucated?
>
>
>
> Linda Walker
>

Some things we just have to deal with.  Here in ny empire bcbs does the same
thing with denials for no authorization, when in fact ther is one already on
file, on the claim, etc.  Every month, or 2 months I call to speak with a live
rep ( even spv's)to only have them reversed for payment.  No logical explanation
except the system does not pick up on the authorization even if it is there on
paper or electronic billing,  Go figure! I gave up more than 5 years now.



The fifth digit is another story altogether?



To: MedicalBillers@yahoogroups.com
From: martasan@...
Date: Thu, 21 May 2009 19:49:19 +0000
Subject: [MedicalBillers] Problems with Kaiser Permanente Claims







Hello,
I'm hoping that maybe some of my fellow medical billers from the Washington DC
area will be able to help me.

I am having a difficult time getting Kaiser Permanente to pay their claims
correctly. This problem only happens at the Rockville, MD Kaiser location and
all claims that I send to Plano, TX are paid fine. Basically, Kaiser denies ever
other claim for reasons such as "5th digit of diagnosis missing" which is simply
not true. I include it on every claim. Some claims are denied due to no auth.
Again, authorization number has been included on each claim. I am at a loss of
what to do.

I talked with them over the phone and sent complaints along with my claim
appeals. Same problems continue happening. I'm not sure how paper claims get
processed once they reach the insurance co., but I get the feeling that either
my claims go to the same "sloppy" data entry person, or Kaiser is simply trying
to hold on to their money as long as possible so that it generates interest for
them before they pay the provider.

At this point, I'd rather do five Medicare claims for one Kaiser claim (have had
no problems with Medicare!). I have asked the provider to contact Kaiser and I'm
looking into getting set up to file electronically with them, hoping that will
make a difference. My provider has a very small mental health practice and so
far electronic billing software has not been cost effective (we use web based
claim filing for most of our other billing).

Any thoughts or suggestions will be much appreciated!

Marta










[Non-text portions of this message have been removed]

97112 is neuromuscular reeducation very specific each 15 min,97530 therapeutic
activities direct one on one with provider each 15 min may require a report
--- On Tue, 5/19/09, christina <chrstna1519@...> wrote:


From: christina <chrstna1519@...>
Subject: [MedicalBillers] difference between codes 971112 and 97530
To: MedicalBillers@yahoogroups.com
Date: Tuesday, May 19, 2009, 7:17 AM








Does anybody know the difference between 97112 and 97530?  They are therapeutic
procedures.
 
thanks christina

[Non-text portions of this message have been removed]
















[Non-text portions of this message have been removed]

Gum Treatment procedure D4341 has been "deferred" for Action Code 08. What needs
to be modified in order for this treatment to be accepted?