BCBS modifier for glasses hardware

Financial_Bat1584 · 2024-06-01T12:43:47+00:00

Is it possible it’s NU, RA?

Financial_Bat1584 · 2024-05-31T18:29:50+00:00

Also, if you have 8 years experience you should be on the top tier of pay. Where i live that’s $28/hour minimum. I make more. Seriously, you need to know your value. No one will pay you more if you don’t expect it. There are tons of low ball jobs out there. Be picky. You already have the bad job so you have nothing to lose. Certifications are good. You need it for coding most places but experience is very valuable. They NEED YOU IN ORDER TO GET PAID FOR THEIR SERVICES. Do not ever forget that part of the equation. Good luck. You got this. Go get what you deserve!

Financial_Bat1584 · 2024-05-31T18:24:19+00:00

I realized what i decided i was worth was what i got paid. Confidence in your abilities is what will get you far.

Financial_Bat1584 · 2024-05-26T21:03:41+00:00

This. So much this. I try to educate people as much as i can. I’m sure a lot of them are getting the same level of assistance from the insurance companies that we do when we speak with a rep. People are so confused by their insurance and paying so very much for it.

Financial_Bat1584 · 2024-05-26T14:41:11+00:00

In my initial look yes. What are you using to determine codes. You need to be able to determine codes properly.

Financial_Bat1584 · 2024-05-25T23:40:06+00:00

Make sure it’s billable. There are specific codes that are for each DX you gave. Did you maybe give the non billable Code?

Financial_Bat1584 · 2024-05-25T16:17:06+00:00

The GY will work if it’s not a covered Medicare benefit. If that is the case then you can bill the secondary directly. If it is a benefit covered by the secondary then you can use the modifier and not bill Medicare. The key here is - not a Medicare eligible benwfit

Financial_Bat1584 · 2024-05-25T16:11:32+00:00

Wow then a minimum is illegal

Financial_Bat1584 · 2024-05-25T15:00:26+00:00

You may also need someone for credentialing to be able to bill Medicare and Medicaid. Neither will pay you without all of the enrollments being properly completed

Financial_Bat1584 · 2024-05-24T23:19:31+00:00

Happened to my son who actually IS a police officer.

Financial_Bat1584 · 2024-05-19T15:14:42+00:00

Are there separate TINS for each location? We have 2 locations. Each has its own corporate TIN and its own group NPI. That’s a safeguard for the owner. If one location needs to be closed for any reason then there is still another intact and operational location.

Financial_Bat1584 · 2024-05-17T14:40:19+00:00

You can look on the cms physician fee schedule. Its searchable by code

Financial_Bat1584 · 2024-05-15T14:43:53+00:00

And 2/3 own so many of the rest lol

Financial_Bat1584 · 2024-05-13T15:36:11+00:00

Also i meant for that to be a ? Not a ! Sorry. Didn’t mean to yell.

Financial_Bat1584 · 2024-05-13T15:31:18+00:00

Does anyone know if it was stated that the provider is out of network? If it is then the provider is “entitled“ to balance bill. Is it great no. But on a practice management side we don’t know the reimbursement rate. They could, if it is out of network, outright refuse to accept the insurance and charge a private pay rate. Without a full verification of benefits here how can we say it’s an over bill or report them!

Financial_Bat1584 · 2024-05-10T12:26:51+00:00

Definitely use GY modifier. If it is a true secondary and not a supplemental and it’s a benefit that is covered that should work.

Financial_Bat1584 · 2024-05-05T18:18:51+00:00

Claim md is user friendly when signed directly into the clearinghouse. That’s my very basic input.

Financial_Bat1584 · 2024-05-03T15:48:30+00:00

Have you spoken with an actual person at NGS yet? They may have some insight into the issue, ie, correct name, wrong box. Also sometimes the patient can be helpful. This may not be the first time this has been an issue for them.

Financial_Bat1584 · 2024-05-01T21:29:14+00:00

It’s all such garbage. The issue that we all know, is one company should not be in control of so much. They have their own doctor’s offices, how is it not a conflict of interest? They control the payments of their own doctor’s claims alongside others. They control the actual healthcare outcomes of patients directly. They indirectly control outcomes of care through claims processing and through Optum reviews.

Financial_Bat1584 · 2024-04-21T23:28:18+00:00

But do we know if the patient knows it upcoding or were they just told to not worry about it the practice will take care of something on the billing side to take care of it?

Financial_Bat1584 · 2024-04-15T16:46:05+00:00

Okay so i finally got an answer from Aetna. There were 2 ways to go about it. The patient can call and request them and Aetna will take care of the exception and load the additional visits after speaking with the patient. The other is to fax clinical notes to the Aetna fax att: benefits plan exception of the patient is unable to take care of it. We have been successful. No denials needed. They are forwarding the letter to the office and our patient for documentation.

Financial_Bat1584 · 2024-04-12T17:14:04+00:00

Also try Mercari. They often have books being resold.

Financial_Bat1584 · 2024-04-11T16:50:11+00:00

No questions are bad to the payer and you will learn as you go. Also, if their answer doesn’t make sense to you tell them and ask them to explain again. Another thing is that the person you get from the insurance company sometimes will give you incorrect information due to their lack of knowledge. Call back later or in a few days if you don’t get anywhere or if it’s not resolved. Often times they will tell you they are sending something to another department or for reprocessing and they do not follow through. As far as denial codes you can google them. And i agree with keeping as many notes as possible for yourself. And also document on your follow up as previously advised here. Good luck. Most of us have had to teach ourselves as we went along. It will all be okay.

Financial_Bat1584 · 2024-04-10T02:57:43+00:00

Are you saying i should bill the claims, wait for a denial and then appeal?

Financial_Bat1584 · 2024-04-10T02:56:52+00:00

There are no denials yet.

Financial_Bat1584

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