We billed an H0032, 90791, 90834, and Ucare paid the H0032 and the 90791 rejected the 90834. If I do a replacement claim what code or codes should get the 59 modifiers as an add on?

I am wondering what video system everyone is using to see your clients for tele-health? Are there agencies using theralink through Procentive? We had already been using the state Vidyo system already, but want to know what else is out there that everyone has had luck with.  Thank you! 

I originally billing our telemed visits to Medicare with POS 02 and the GT modifier; they paid, but at a reduced rate.  I contacted Medicare and was told that the claims need to be filed with POS 11 and a 95 modifier, so I did re-openings on all of them.  When they reprocess the payment is the same as it was.  

Is anyone else having this issue or know of a different way to submit to the payment equals in-office reimbursement rates? 

Hello everyone,

Just wanted to give you a heads up, we have received the following notice from DHS of eligibility downtimes that will be coming up.  

Take care and stay healthy!

Real Time Eligibility X12 users,

On Sunday May 3, 2020 our system will be un-available from 7:00 a.m. to 9:00 a.m., CDT due to system maintenance.

Real Time Eligibility ongoing maintenance schedule windows below:

Scheduled mainframe maintenance that may impact Eligibility 270 Inquiries below are approx. as times may vary depending on task or if complications arise.

• Weekdays 1:00-1:20 a.m.

• Weekdays 11:00-11:20 a.m. (These times may vary on State Holidays)

• Monday 2:00-2:10 a.m.

• Saturday 1:00 – 1:10 a.m.

• Sunday 6:00 a.m. – 12:00 noon Our Operations team may perform server restart/updates during this scheduled window

• Sunday 8:00 p.m. -1:00 a.m. scheduled maintenance window: Real Time 270 X12 Application interruptions reserved for system maintenance. Normal impact for Eligibility to be brought back up is around 08:10 p.m. In addition, there may be several momentary outages between 08:00 p.m. Until 01:00 a.m. Monday.

When using the H2012 (bundled code) there must be a group therapy and at least 4 units of skills. Is this also true for the S9480 code for commercial? Or can you bill S9480 with just skills and no group therapy 

Insurance termed so I posted the takeback to the clients account. What exactly are the next steps that I need to do so I can rebill this to secondary ins for the full amount of the claim??? 

Buckle up, this is a deep dive.

To understand the nature of the question, it is important to first understand that when my organization sends claims, each day usually has more than one service line for the same code, because clients attend more than one "group" in one day and the services are billed separately. So as a result, we have multiple service lines, for the same client, on the same day, with the same code.

When posting payments, my organization requires payments to be applied in proportion to the number of units to which that payment is being applied.

With this in mind, I am trying to find a way to prevent Procentive the following universal problems:

—Automatically adjusting off money that I want to leave as a balance

—Applying co-pays more than once on treatment days where we bill 2 separate "chunks" of time rather than all units on a single service line

—Improperly allocating funds respective to unit counts (This is my biggest issue with procentive overall. see below)

When, for example, the allowed amount (B6) is 50% of what was submitted, The claim is sent as 3 units and 1 unit of the same code, but the remit bundles these into one lump sum for 4 units. So, Procentive will:

-Put all the money on the line with 3 units

-Adjust the remaining balance

-Adjust 100% of the remaining 1 unit. 

In this scenario, I need to manually tab through every field in payment entry mode to ensure that 3/4 of what was paid goes on the line with 3 units, and 1/4 goes to the line with 1 unit. The only time Procentive gets this right is when B6=100% of submitted charges. Adjustments, specifically, are causing the imbalance. 

(Using the "allocate payment" dialog is not a viable solution, it only works when [B6=100%] OR [there is only 1 CAS code AND all claims paid are in a contiguous time span AND only one client account is being paid on the remit.])

I don't know if this is something that can be fixed on the user end (I have tried messing around with the "rules" for the payment entry mode, and while useful for other tasks, I could not solve any of these problems using them, or any other settings within procentive.) This is a major time drain when payment posting, especially when there are copay/coinsurance/deductible involved. To speed things up I usually just apply the copay to one line where possible, but the payment per unit rule is not something I can do differently. 

Am I overlooking something that I could be utilizing? Can systems engineers write new code to address this? Do we need to change our billing process entirely if we want to avoid this problem? I have been trying to find a solution to this for over a year and I am completely stumped.

I know there is a report for exporting emails from the Contacts module but is there a way to export emails in the clients module? We would also like mailing addresses, if possible.

For our clinic's group sessions we have a mixture of clients who pay for services through insurance, and also those who choose to go the private pay route.  From what we can tell within the Appointments module, there isn't a quick "at a glance" way to determine which clients are private pay, and which ones have insurance coverage.  Does anyone know of a setting or something you have done to quickly show which clients are private pay while remaining in the Appointments module?  The primary reason wanting to see this info is when private pay clients check in, they are responsible for making a payment at the time of the appointment.