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Claims Articles and Resources

News and Important Information

What Medical Necessity Tools Does Find-A-Code Offer?

Keys to Successful Claims Filing

See also Chapter 1 - Insurance & Reimbursement in Find-A-Code's specialty specific Reimbursement Guides or the ChiroCode DeskBook for important claims processing information.

Claims Articles and Resources Articles

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Q/A: How Do I Bill a House Call?

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Question If a provider makes a house call to/for a patient, is there a way that it is represented on the claim form?  A modifier, or something else? Answer Modifiers are not used to identify that a service was performed in the patient's home. However, other modifier rules must be followed (e.g., modifier GP ...

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Anthem is Changing their Timely Filing Requirements for All Plans, Including Medicare Advantage

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Anthem has been very busy sending out notices stating that, beginning October 1, 2019, all timely filing deadlines for claims will be 90 days. We've seen this letter, or something very similar, sent to doctors and other healthcare providers from California to Kentucky. In their notice, Anthem states: "Effective for all commercial ...

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A United Approach

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A United Approach As auditors, we all have a different perspective when evaluating documentation. It would be unreasonable to think that we all view things the same way. In my opinion, differing perspectives are what makes a great team because you can coalesce on a particular chart, work it through and ...

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What Medical Necessity Tools Does Find-A-Code Offer?

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Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ...

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Q/A: How Many Diagnosis Codes do I use?

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Question: My patient has a lot of chronic conditions. Do I need to include all these on the claim? I know that I can have up to 12 diagnoses codes on a single claim. What if I need more than that? Answer: More is not always better. You only need to ...

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Prolonged Services

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Prolonged Services I find in my own audit reviews that the prolonged service code set is often mistreated: they are avoided and not used even when the scenario supports them, or they get overused and improperly documented. Prolonged services are used in conjunction with all types of Evaluation and Management (E/M) ...

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Date of Service Reporting for Radiology Services

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Providers need to ensure that they are reporting radiology dates of service the way the payer has requested. Unlike other many other professional services which only have one date of service (DOS), radiology services can span multiple dates. Medicare requirements may differ from professional organization recommendations.

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Understanding NCCI Edits

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Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...

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Home Oxygen Therapy

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Home Oxygen Therapy Guidelines

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Are You Protecting Your Dental Practice From Fraud?

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With the expansion of dental coverage through Medicaid and Medicare Advantage plans, an ever-increasing number of dental claims have come under scrutiny for fraud. One such payer, Aetna, is actively pursuing dental fraud by employing their special investigative units (SIUs) to identify and investigate providers who demonstrate unusual coding and ...

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Keys to Successful Claims Filing

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There are many factors that can contribute to your success in filing claims and getting reimbursed.  The information below is from the CMS website. Completing Item 12, Patient's or Authorized Person's Signature, on the CMS-1500 form for a non-assigned claim A signature on file (SOF) indicates the supplier has obtained the beneficiary's one-time authorization on ...

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Dual Medicare-Medicaid Billing Problems

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It is important to keep in mind that Medicaid is run at a state level so there can be some differences when it comes to coverage. However, the rules regarding balance billing of covered services is set at the federal level. The law states (emphasis added): A state plan must provide ...

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WHO Said ICD-11 is Coming Soon

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Sooner or later ICD-11 will be released, and it sounds like it will be sooner than later. WHO released the news on June 18, 2018. The World Health Organization stated “ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come ...

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Why Is Medicare Denying My Claims for Mammography and Breast Biopsies?

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When Medicare updated their systems with the updates to mammography and breast biopsy policies some ICD-10-CM codes were inadvertently left out. The omitted new codes are N63.11-N63.14, N63.21-N63.24, N63.31, N63.32, N63.41, and N63.42, which will replace the truncated ICD-10 diagnosis N63. The Centers for Medicare & Medicaid Services (CMS) will...

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Avoiding D9 Denials

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The following is according to WPS. Please make sure what is bold below is entered verbatim on the second line of the "Remarks" section. This should be the only thing on the second line of remarks: Patient control nbr - If you are changing or adding a patient control number Admission hour - If you are changing or adding the admission ...

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Documentation for Skilled Nursing Facilities

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The Medicare Learning Network provides guidance on required documentation for Skilled Nursing Facilities (SNF).

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Increase Revenue by Outsourcing Medical Billing

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Many practices are starting to weigh the benefits outsourcing medical billing compared to keeping it in-house....

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Referring and Ordering Physician - CMS-1500 Box 17

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Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicians who order services or refer Medicare beneficiaries must report this data. Similarly, if Medicare policy requires you to report a supervising physician, enter this information in Item ...

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Revenue Cycle 101: Reduce your Denials with These Tips

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Your practice seems to be doing everything right. You have a team in place, established your RCM process and you’re submitting claim after claim – but your denial rate isn’t going down....

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Filing a CMS-1500 Claim form to Medicare PUB-100 40.1.1.1

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An independent clinical laboratory may file a paper claim form shall file Form CMS-1500 for a referred laboratory service (as it would any laboratory service). The line item services must be submitted with a modifier 90. An independent clinical laboratory that submits claims in paper format) may not combine non-referred (i.e., ...

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What Claim Forms are Revealing

What Claim Forms are Revealing

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Reimbursement Guides
2020 Edition

Find-A-Code's 2020 specialty specific Reimbursement Guides give you the coding, billing, and documentation support you need to get paid properly and keep it.

  • Medicare
  • Procedure & Supply codes
  • Documentation
  • Compliance
  • HCC information
  • ICD-10-CM codes


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