Comments for Medical Billing Company | Capture Billing

Comment on Practice Management: 5 Must Dos for Efficient Medical Receptionists by Heather

Heather — Fri, 17 Feb 2012 22:06:06 +0000

This is all really helpful! I go to a medical office school and I shared this with other people in my class. It’s a great post. Keep them coming!

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Carol

Carol — Wed, 15 Feb 2012 14:59:51 +0000

Regarding the PT AWV: we are looking for clarification on a point. Can a MC patient see more than one provider in a years time for the AWV? that is to say can he see an MD for one AWV and the next week see a PT for a review of functional ability and be cover by both visits?

Comment on 2011 Medicare Codes for Flu Shots: Q2035, Q2036, Q2037, Q2038 by Carlo Raybould

Carlo Raybould — Tue, 14 Feb 2012 22:44:33 +0000

Hi-ya, This 2011 Medicare Codes for Flu Shots:Q2035, Q2036, Q2037, Q2038 article is charming, I really like this material
I’d really like to know if you have an RSS feed so I can find out when your site post more posts on the blog

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Manny Oliverez

Manny Oliverez — Mon, 13 Feb 2012 22:23:49 +0000

We don\’t deal with rural areas much but in my reading I have heard that the government does have some special programs in these areas that may be undeserved. You may want to talk to your Medicare carrier rep to see what information they have.

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Carol

Carol — Mon, 13 Feb 2012 18:05:20 +0000

Thank you for getting back to me. I am curious about the special rules for our being a rural hospital. Can you tell me about that?

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Manny Oliverez

Manny Oliverez — Fri, 10 Feb 2012 18:09:45 +0000

After reading the definition of a medical professional it does look like a Physical/Occupational Therapist would qualify. I have not come across that. In addition there are special rules for rural hospitals that may apply. At any rate you can rest assured that the claim will deny if if they are not considered an Eligible Provider. Yes, as with other Medicare claims you should have a referring provider.

The reimbursement for the AWV depends where you are located but the national average is 166.44 for G0438 and $ 110.96 for G0439.

The Annual Wellness Visit should be paid independent of any other service provided on the same day. Hope this helps and gets you pointed in the right direction.

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Carol

Carol — Thu, 09 Feb 2012 20:59:51 +0000

I work in the Rehab dept of a small rural hospital. We have a few questions regarding the Annual Wellness Visits (Initial and subsequent). A Physical Therapist/Occupational Therapist is medical professional and a licensed practitioner, so it would appear that we may perform the annual visits for our rural population. 1)Do we need an MD reperral for this as we otherwise do? 2)What is the typical re-embursement for these visit? 3)Will Medicare cover for an MD visit as well as a PT visit to one individual within the same time frame?

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Manny Oliverez

Manny Oliverez — Thu, 09 Feb 2012 17:45:41 +0000

Erika, upon researching this CPT code there are specific guidelines that must be met and we just want to make sure the following criteria is met:

99366
Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified health care professional

***Are you billing for a nonphysician?

Face-to-face participation by minimum of three qualified people from different specialties or disciplines

***Is there a minimum of 3 qualified people from different specialities? If so, who is billing for each provider? Are you billing for all three providers? Have you coordinated billing with the other providers if applicable?

Only participants who have performed face-to-face evaluations or direct treatment to the patient within the previous 60 days

There are several CPT codes for home visits. Do any codes from 99341 – 99350 or 99500 – 99602 apply?

I don\’t have enought information to give you a good reason why you are getting those denial codes but hopefully the questions I raised can point you in the right direction.

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Erika

Erika — Wed, 08 Feb 2012 16:39:35 +0000

I have been trying to get a correct Medicare code for a direct face to face homcare patient code. I have been billing 99366 to Medicare and they are denying it with a denial code stating “This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service /procedure has not been recived/adjudicated.” I have read and read and haven’t come across what I am looking for please help me.
Thank you;
Erika

Comment on Medicare: Video Helps Explain New Influenza Vaccine Q Codes for 2011 by Manny Oliverez

Manny Oliverez — Tue, 07 Feb 2012 21:51:49 +0000

We frequently bill problem visits with the flu vaccine and administration and have not had any issues getting reimbursement for all three line items you’ve indicated above. Did you append modifier -25 to the office visit? If not we recommend you resubmit the claim with the 99214-25. This should alleviate the reimbursement issue. Also make sure that the referring physician is indicated (even for our family practice we have to put in the referring physician – we use the actual PCP even if it is one of our own doctors) because otherwise the claim will be denied for missing/invalid information.

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Manny Oliverez

Manny Oliverez — Tue, 07 Feb 2012 21:50:15 +0000

Most likely Medicare is denying the G0439 because the G0438 should have been billed in 2011. As these codes were only effective beginning 1/1/11 the appropriate CPT code to bill for the AWV is the G0438 and the subsequent G0439 in the following year. Also make sure that you are checking for frequency, if the initial AWV was billed out less than 12 months ago then that might also explain the denial. In our experience, it would be appropriate to rebill the visits as the G0438 if appropriate and then contact Medicare with the error and ask them if they will initiate retraction based on the corrected claim or if they want a refund issued to them. Some of the MACs are great about direct contact. We have been able to call Highmark Medicare in our area and deal with redeterminations using their dedicated redetermination phone number. We also correct claims via the redetermination center. Their representatives are great about advising us as to how they want specific things handled. Giveyour local Medicare Carrier a call.

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Manny Oliverez

Manny Oliverez — Tue, 07 Feb 2012 21:46:41 +0000

That solely depends on the patient’s individual insurance policy. In our experience we have seen deductibles on both wellness and sick visits and it depends directly on how the insurance company processes each individual’s claim. A way to address this is to check the patient’s eligibility on the insurance websites. The websites are usually a great guideline and may give you additional information, especially on deductible percentages and whether or not wellness visits require a copay – however, we never really know until the claim is actually accepted, processed and paid by the insurance company!

Comment on Medicare: Video Helps Explain New Influenza Vaccine Q Codes for 2011 by Tina

Tina — Mon, 06 Feb 2012 18:40:03 +0000

I have submitted G0008 and Q2038. They also had a 99214 visit for different reason. Medicare is not paying G0008 with reason codes COB15 and M80. I never had a problem with getting paid for administration before. Pleas help.

Comment on Blog by MONEY® Money News » Medical Billing Company Prepares for ICD-10

MONEY® Money News » Medical Billing Company Prepares for ICD-10 — Mon, 06 Feb 2012 17:02:24 +0000

[...] with the new regulations or they may have trouble with insurance reimbursement. These changes in medical billing practices are significant enough to have caused marked slowdowns in billing and payment in other [...]

Comment on Blog by MONEY® Money News » Medical Billing Company Teaches Medical Terminology for the Allied Health Professional at Local Community College

Mon, 06 Feb 2012 13:01:40 +0000

[...] five session class will help students prepare for the CPC certification exam and to succeed in the medical billing and coding field. As medical billing standards change and become more complicated, qualified [...]

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Fara

Fara — Fri, 03 Feb 2012 02:15:00 +0000

I have been erroneously billing G0439 last year (2011) for the AWVs and Medicare paid. Now it’s time for the same patients to come back in for another AWV and I have been billing the same G0439, but Medicare is now denying it. Do you think Medicare is denying this year’s G0439 because I should have been billing G0438 for all those first-time AWVs? What should I do. I am kind of thinking I may have to refund Medicare all of the payments for the G0439 last year (2011-because I should have been billing G0438 instead) and then rebill with the G0438 for all those patients in 2011. What do you think?

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Kelli

Kelli — Sun, 29 Jan 2012 15:57:00 +0000

I have a provider that is doing some of the wellness checks and she is aksing me if this fees could be applied to the deductible for the patient or it this is something that does not get applied to the patient deductible?

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Manny Oliverez

Manny Oliverez — Fri, 27 Jan 2012 19:46:07 +0000

With Medicare it’s never how to code to get paid it is what procedure was performed and was it medically necessary. Then you work on getting the claim paid properly which may mean getting payment from the patient. That said, 99397, Routine Preventative Visit is completely different than a G0438, Annual Wellness Visit (AWV). You can actually bill for both codes at the same visit if you performed both services and documented properly. The post above outlines what is part of the Annual Wellness Visit. Your CPT book should list what must performed and documented for a 99397 which is a non-covered service. The practices we service bill for both visits and the patient pays for the 99397. There are also times when there is a Well Woman Exam given at the same time and we that we carve out of the 99397 and bill Medicare a G0101 and Q0091.

Comment on 2011 Medicare Codes for Flu Shots: Q2035, Q2036, Q2037, Q2038 by Manny Oliverez

Manny Oliverez — Fri, 27 Jan 2012 18:56:49 +0000

Yes, you need to send the NDC number with all claims. Remember there is a specific format that the number must be in to be accepted. You will find the NDC in the package insert for the vaccine.

Comment on How to Bill for Flu Shots by Manny Oliverez

Manny Oliverez — Fri, 27 Jan 2012 18:39:38 +0000

Hi Mary, typically we when we bill out an office visit 99213 with the flu vaccine 90658 and the admin 90471 our reimbursement rate for any of the services is not reduced. The multiple procedures rule does not usually apply to a vaccination. Have you checked your fee schedule with specific payers? What have the insurance representatives told you when you have called to follow up on this payment discrepancy? Please send us more information and we can try to point you in the right direction. Based on our experience, we have not had problems getting the proper (not reduced) reimbursement when billing out these 3 CPT codes together.

Comment on 2011 Medicare Codes for Flu Shots: Q2035, Q2036, Q2037, Q2038 by Beny

Beny — Thu, 26 Jan 2012 06:33:09 +0000

Do I need to write the ndc number to bill Medicare for the flu shot?

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Pat

Pat — Sat, 21 Jan 2012 18:06:56 +0000

When is 99397 used vs G0438? Which would be the best way to be paid since some folks balk at 99397.

Comment on How to Bill for Flu Shots by mary

mary — Thu, 19 Jan 2012 23:07:16 +0000

if we do bill a 99213 along with 90658 and the 90471 will the insurance pay us less money on the office visit. i have been billing just the flu and the office code without the administration because sometimes insurances will decrease the payment considering it part of another procedure. what is your opinion on this

Comment on Medicare: Video Helps Explain New Influenza Vaccine Q Codes for 2011 by Manny Oliverez

Manny Oliverez — Wed, 18 Jan 2012 01:16:59 +0000

Diane thanks for your question. There is only one administration code for Medicare flu shots and that is G0008. CPT Code 90471 or 90460 would not be used for the flu admin code for Medicare. Also just an FYI, 90471 may be appropriate without an office visit but 90460 may not be appropriate even if there is an office visit.

Comment on Medicare: Video Helps Explain New Influenza Vaccine Q Codes for 2011 by Diane

Diane — Wed, 18 Jan 2012 00:55:25 +0000

When billing Medicare we use the CPT G0008. Should we also use the CPT codes 90471 without office visit and 90460 visits with office visit?

Comment on Medical Billing Videos by Medical Billing Company Produces Medical Billing Tips Videos

Medical Billing Company Produces Medical Billing Tips Videos — Tue, 17 Jan 2012 13:36:35 +0000

[...] Medical Billing Videos [...]

Comment on Your Medical Billing Company by Healthcare News January 13, 2012 | MEDDENTS : Healthcare Business Alliance

Healthcare News January 13, 2012 | MEDDENTS : Healthcare Business Alliance — Sun, 15 Jan 2012 11:49:13 +0000

[...] Billing provides outsourced Medical Billing Services to small and large medical practices. Its new website outlines and describes all the services that [...]

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Manny Oliverez

Manny Oliverez — Thu, 12 Jan 2012 22:07:21 +0000

Keke, I have a few questions for you before we can point you in the right direction. First of all, a modifier 25 should not be necessary and is usually not billed out on the G0439. In fact, depending on what was billed, a modifier should not be used. What are the exact services that you billed out for and what are the diagnoses?

The issue with the EKG may be the diagnosis. Our local Medicare carrier has a list of diagnoses that indicate the medical necessity and usually HTN is not billable. Check with your local carrier.

The G0101 is for the female Pelvic and Breast Exam. Was the exam done for the Digital Rectal Exam? Let us know exactly what you billed and maybe we can help you!!

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Keke

Keke — Thu, 12 Jan 2012 21:45:03 +0000

Good posting. Thank you all. I have a question about the G0439. I added a Modifier 25 to it and added the 93000 with a ICD for 401.9. I got a rejection from Medicare saying the Modifier is not right. Can I add Modifier 59 and resubmit. Also, if the Doc did a male exam can I add G0101 to it. Need help.Thank you.

Comment on HIPAA 5010: Are You Ready by Healthcare News December 31, 2011 | MEDDENTS : Healthcare Business Alliance

Healthcare News December 31, 2011 | MEDDENTS : Healthcare Business Alliance — Fri, 06 Jan 2012 11:34:42 +0000

[...] Billing has been working toward preparing for the transition to HIPAA Version 5010 for the past several months. The time has come and we are ready. As of January 1, 2012 all [...]

Comment on 5010 for Insurance Claim Submission is Here by The Nerdy Nurse

The Nerdy Nurse — Sat, 31 Dec 2011 01:29:28 +0000

I work as a systems administrator for a home health software at a healthcare facility and I have been up to my ears in 5010 testing and moving to production. There were far more bugs in the claims and software than I thought would be possible. We have moved to production status long before the deadline but we're running into rejections for claims. I have told anyone and every to be prepared for rejections. 5010 claims are requiring so much more information there are going to be rejections for things that you never had before because they are asking for information they haven't asked before.
I wish everyone the best of luck!

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Manny Oliverez

Manny Oliverez — Fri, 30 Dec 2011 20:54:14 +0000

Yes what is listed in MLN Matters is what you must do and document in order to bill a Annual Wellness Visit (AWV). The only practices we have using G0402, G0438, and G0439 are primary care practice. You can bill the AWV with a pap and pelvic. You can also bill a routine physical 99387 or 99397 if it is done. So technically you can bill the following: 99387 Routine Preventative Medicine Exam G0438 Annual Wellness Vist G0101 Pelvic and Breast Exam Q0091 Pap

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Kari

Kari — Fri, 30 Dec 2011 20:01:53 +0000

Kinda confused on the "what is included in an AWV w/PPPS?" from MLN matters, pg2-3. Does all 11 of these have to been be done at the visit. And is it true this these codes (G0438,G0439&G0402) can be used at any speciality Dr. Also,can you bill a G0438/G0439 w/a pap and pelvic.

Comment on Medicare Changes GA and Adds GX Modifier for Advanced Beneficiary Notices by Manny Oliverez

Manny Oliverez — Thu, 29 Dec 2011 16:21:39 +0000

Yes! You will need to use the GA modifier to tell Medicare that there is a valid ABN on file so that if Medicare denies the claim you are able to bill the patient. Without the Advance Beneficiary Notice (ABN) you may not be able to bill the patient. With the GX modifier you are telling Medicare that an ABN was obtained for a service that is not covered. This is considered a voluntary ABN because it is really not necessary according to Medicare. You are having the patient sign the ABN just to let them know, as a courtesy, that the service will not be paid by Medicare. For specific information about how to use these modifiers contact your local Medicare carrier.

Comment on Medicare Billing for a Well Woman – G0101,Q0091,G0438,G0439,99387 & 99397 by Manny Oliverez

Manny Oliverez — Thu, 29 Dec 2011 16:01:00 +0000

Krissa are you asking about a Routine Well Exam? If so, that would be billed using a 99387 or 99397 depending if it is a new patient or existing patient. A diagnosis code of V70.0, routine physical exam, would be appropriate. Routine exams are a non-covered service by Medicare so the patient would be responsible for the entire amount. There is a calculation if you are also doing a Pap, pelvic and breast exam where you carve out those procedures and bill them separate from the routine exam. You should also add a GZ modifier. Come back to the website in a couple of weeks. We are giving away a booklet on how to bill a routine exam with a well woman exam to Medicare. Also look at other posts on our website about billing Medicare. If you were asking about the Annual Wellness Visit (AWV) check out my post, http://www.capturebilling.com/medicare-g0438-g043.... If you were asking about the Welcome to Medicare exam see http://www.capturebilling.com/welcome-to-medicare... . The best thing you can do is go to your local Medicare carrier website. There you will find information on exactly how to bill for these and other procedures.

Comment on Medicare Billing for a Well Woman – G0101,Q0091,G0438,G0439,99387 & 99397 by Krissia Ramos

Krissia Ramos — Wed, 28 Dec 2011 16:57:58 +0000

I have to bill a wellness exam, how should I code that?

Comment on Medicare Changes GA and Adds GX Modifier for Advanced Beneficiary Notices by Shilpee Raina

Shilpee Raina — Wed, 28 Dec 2011 16:03:54 +0000

Shall we post a modifier (GA or GX) in case the claim gets denied for preventive check up as a non-covered service?

Comment on How to Bill for Flu Shots by Manny Oliverez

Manny Oliverez — Thu, 22 Dec 2011 15:55:33 +0000

John sounds like you are going to have a flu clinic where you see a lot of patients at one time. We once had 400 patients come through in 2 hours at a flu clinic we held at our medical office. I worked for The Walt Disney Company in the past and know about crowd control and how to get people though a line fast. It worked well and the wait was only a couple of minutes. For your clinic you still would bill these flu shots just as you would normally. Use 90471 (Immunization Administration) and 90657 (Influenza vaccine for children 6-35 months) or 90658 (Influenza vaccine for individuals 3 years or older) as appropriate for the patient’s age. For Medicare use G0008 for the administration code and the correct G code for the vaccine which is dependent on the manufacture (See above for codes). The V04.81 diagnosis typically goes with the flu shot. Most insurance company no longer reimburse for a 99201 or 99211 so if they are just coming in for the flu shot you really don’t need to bill for the encounter. These encounter codes are the codes that usually cause the patient to have a copay. Billing just for the admin and vaccine should not cause the patient to have a copay. That has been our experience with our pediatric practice. As always you should check with your insurance carriers for their specific billing, reimbursement and documentation rules.

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Manny Oliverez

Manny Oliverez — Thu, 22 Dec 2011 15:25:05 +0000

Samson if a patient has not been seen in your office for any reason for over 3 years then that patient would be considered a new patient and it would be appropriate to bill a new patient CPT code. Also keep in mind that with the preventative medicine codes you not only have to choose new or existing patient but you must also consider the patients age when choosing the appropriate code. Let me know if this helps.

99385 – New Patient Preventative Medicine Visit (Age 18-39 years)
99396 – Established Patient Preventative Medicine Visit (Age 40-64 years)

Comment on Medicare G0438 – G0439: Two New Annual Wellness Visit Codes by Samson

Samson — Thu, 22 Dec 2011 14:34:12 +0000

If a patient had a service with 99385 and after 4 years he again come for preventive visit, shall we bill 99385 or do we consider it as periodic visit and bill 99396. (Since if the patient have no service between 3 years we consider it the patient again as new patient)

Thanks
Samson

Comment on How to Bill for Flu Shots by John K

John K — Thu, 22 Dec 2011 13:12:12 +0000

If my office wants to do a sort of flu express to administer the vaccination without having patients need to pay a copay, what diagnosis, procedure and encouter codes do use?

Comment on Looking for the Meaning of Meaningful Use by Bennie Neira

Bennie Neira — Thu, 22 Dec 2011 04:05:10 +0000

Excellent visual appeal on this web site. I’d rate it 10 of 10.

Comment on How to Bill for Flu Shots by Manny Oliverez

Manny Oliverez — Wed, 21 Dec 2011 21:27:03 +0000

The best place to start is the CMS website. https://www.cms.gov/apps/physician-fee-schedule/o... Through the website you can then narrow your search parameters to look for your Specific Locality or Specific Carrier/MAC. Just enter in the codes you are looking for in the HCPCS Code Box and search and this should bring up the requested information. Otherwise, depending on your local Medicare Administrative Contractor (MAC), go directly to their website and they should also have an available fee schedule for you search.

Comment on 2011 Medicare Codes for Flu Shots: Q2035, Q2036, Q2037, Q2038 by Manny Oliverez

Manny Oliverez — Wed, 21 Dec 2011 21:24:55 +0000

Start with the CMS website at www.cms.gov and you can search for many terms under “secondary payer Medicare”. The overview page is a great starting place with some general information. The FAQ sheet also provides additional basic information: https://www.cms.gov/MLNProducts/downloads/MSP_Fac.... There are also SEVERAL manuals available on the CMS website for Medicare Secondary Payer rules but basicly when Medicare is secondary you will need to send them the apprpriate G code. And yes it can get complicated.

Comment on Medicare Billing for a Well Woman – G0101,Q0091,G0438,G0439,99387 & 99397 by Manny Oliverez

Manny Oliverez — Wed, 21 Dec 2011 21:21:18 +0000

YES. The parameters of the G0402, Welcome to Medicare exam, are very specific. Remember a G0402 is not an "annual exam”. The G & Q codes can be billed with the G0402. The GA signifies you have a valid ABN on file. Billing as you’ve listed is appropriate as long as you have met the docmentation and medical necessity requirements.

Comment on American Academy of Professional Coders Has Elected Manny Oliverez of Capture Billing as Local Chapter Vice President for 2012 by Manny Oliverez

Manny Oliverez — Wed, 21 Dec 2011 15:28:35 +0000

Ali thank you very much. Our AAPC chapter has seen much growth in the past several months and we are working to make it even better. We have added a memebership chair to grow our chapter even bigger so that more people can take advantage of our coding classes to help them advance in their field. Thanks again and hope all is going well with your business.

Comment on American Academy of Professional Coders Has Elected Manny Oliverez of Capture Billing as Local Chapter Vice President for 2012 by Ali Ziehm

Ali Ziehm — Wed, 21 Dec 2011 13:06:39 +0000

Congratulations on the appointment, Manny! You are a mover and a shaker! And the AAPC is a well-respected and widely recognized authority on all things bililng and coding. Good company! Ali Ziehm

Comment on Q&A: What are the Medicare Annual Exam Codes and Newborn Codes? by Brenda O

Brenda O — Wed, 21 Dec 2011 11:09:48 +0000

I believe the Newborn hospital codes have been updated to
99460 initial
99462 subsequent
99238 discharge
99463 admit/dc same day

Comment on Q&A: What are the Medicare Annual Exam Codes and Newborn Codes? by Manny Oliverez

Manny Oliverez — Wed, 21 Dec 2011 04:33:18 +0000

No I am confused. I mistakenly copied the deleted codes instead of the current newborn codes. Thank you for catching that. That is why I have a disclaimer

Thanks Again!

Comment on Q&A: What are the Medicare Annual Exam Codes and Newborn Codes? by R.Fisher

R.Fisher — Wed, 21 Dec 2011 01:01:55 +0000

I'm confused…are Medicare newborn codes different than regular new born codes? I bill 99460-Initial, Newborn, 99462-Subsequent, Newborn, 99238-Discharge, and 99463-Initial and Discharge Same Day, Newborn. I don't see the codes you've listed even in the CPT book.