Question about the functionality of the Diagnosis tab as it relates to Inpatient (Residential calendar) billing.  The Diagnosis tab on the Change Client window has the capacity to record detailed, extensive patient diagnosis history, but when it comes to billing inpatient/residential claims through the residential calendar in the time module, all the distinctions from that tab are lost - it seems the full history is pulled in to the claim, regardless of program, date, or status.  Is there a way to use the full capacity of this tab and not have most/all (including duplicates) pull into the claim?

We received information from Availity stating there may have been an issue with some ERAs from Anthem recently,

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At times, we have clients who return to services with a previously unpaid CCD.  (We don't send past due accounts to collections.)  

In this particular case, the CCD is a result of a termed MA PMAP, after which the clinician continued to provide services. Balance owing is close to $1000. (We were hoping for a retro so didn't suspend services...)

Now the client returns having once again obtained an active MA PMAP plan.

What would you do in this situation? 

Does anyone know if a patient has MA or a PMAP as a secondary and their commercial primary denies for timely filing how I can send to secondary to receive payment?

I just got off the phone with a commercial insurance plan as I was checking on denied claims for a patient. This patient has MA has a secondary. The commercial primary is denying due to the COB box on the electronic claim was checked yes. Commercial insurance rep told me that if a patient has Medicaid/Medicare that box can't be checked yes. Can someone please help explain this to me and why? Where is that box in Procentive? I have numerous denied claims for numerous patients with this same issue?

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Hello - I noticed that sometime last week MN DHS updated there Telehealth Billing (COVID) section to show that we should be billing with POS Office and Modifier 95. Up until recently we have been billing under POS Office with no modifier as that was the original direction given by DHS. Note, we were not a Telehealth Provider prior to COVID. 

Has anyone else been billing CCDTF with POS Office WITH Mod. 95????

Thank you - Jeremy

Has anyone been able to successfully bill and receive payment for the Comprehensive Assessment ($162.24) with HealthPartners PMAP? 

Jeremy

Wondering if anyone has come across this scenario yet.....we have clients coming into the office and being seen via telehealth. When submitting claims w/ place of service (pos) office, no modifier is needed; for telehealth a modifier is needed for most payers. Currently, I have to look in the Appointment Module to see which clients are coming into the office so I know to change the pos to "office" ( right now, I only have Telehealth pos available for providers as that is the majority). Unfortunately, I added the telehealth modifier when I billed them. Anyone have any ideas how to handle this when it becomes half office and half telehealth clientele?

There is a lot of info out there about Insurance companies waiving deductibles and copays during COVID.  I have not seen any ERAs come thru where the copay/deductibles have been adjusted off.All service dates are still being applied towards copays/deductibles. If this is the case, shouldn't the insurance companies be paying the contract rate in full? Wondering how everyone is handling this....Thanks~Tina

Please see our Live Updates page regarding an intermittent issue that could have occurred regarding Audit Ready service lines.

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