Online Class Schedule July – Sep

I have about 35 webinar topics and in the past I have offered them consecutively so that I could offer you guys the widest range of information. However, I received several emails from readers telling me that they had missed the class they needed and they would like to know when was it coming back up again. 

It turns out that “next year” is the wrong answer. 

So, here is the schedule for the next three months. My two most popular classes will be repeating, and I have five new topics. If you miss the class you needed, send me a note or give me a quick call. I will be happy to arrange a special class for you or your office. Also, here is the link to my previous topics. If you would like a special class on any of those topics as well, we can set that up. 

Here you are: 

Date                                                                              Topic

July 1st                    Common medical terminology and basics of billing

July 15th                 Timely filing and follow up

July 29th                Technology: Making it work for you and                                                                   safeguarding your data

August 12th          The global period and modifiers 24, 78, and 79

August 26th          Billing for immunizations and J-Codes

September 9th     Psych billing – Parity, Carve Outs, and how to verify

September 23rd   Maximize per patient reimbursement (Family                                                         Practice/Internal Med)

Space is limited. Each class has spaces for 10 people so that everyone can get a chance to participate in the question and answer portion of the lesson. Each class is an hour long. The classes are comprised of 30 minutes of instruction and 30 minutes to answer questions. I have learned to leave the question and answer period long so that I can address questions about how the topic applies to your situation and your specific practice. Please call (909) 374-5439 to reserve your spot. 

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I am going to save you six hours of phone calls to insurance companies. Aren’t I wonderful?

One of our providers recently moved. Those of you who have gone through this can commiserate with me.

Six hours of phone calls,faxing, and emailing later, her address was updated with the insurance companies. Mostly.

So, I am going to give you the results of our efforts in blog form and again in spreadsheet form. Yay, spreadsheets! If any of you out there have other contact info for the provider relations/ credentialing/provider demographic update departments for any other insurances, please leave a comment or shoot me a quick email.

Medicare and Medicaid require that you send them an application form to update your servicing location. If you are an individual provider, send Medicare a cms855i and if you are a group, send in a cms855b. If you don’t know whether you are an individual or a group, call provider enrollment. For Medicaid, I suggest calling your individual state Medicaid and having them direct you to the proper form. I also put the Medicare forms on the new and improved links and tools page.

The rest of the insurances simply need an updated W9 form.

Aetna – Update on Aetna.com. Here is the direct link: http://www.aetna.com/docfind/custom/provider/data_correction.html

Blue Cross – Fax W9 to (818) 234-2836, attn: Anthem Provider Database Management.

Blue Shield – Fax in a W9 to (916) 350-8860, attn: Blue Shield Provider Contracting

Caremore – Fax W9 to (562) 977-6141, Attn: Caremore

Cigna – Email attached W9 to intake_pbm@cigna.com, subject line: Provider Practice Address Change

Health Net – Fax form to (877) 897-7910, Attn: Health Net PDM

IEHP – Email the provider Service Representative for your city. You will need to call them and get that info. The only one I have is for Montclair, CA and that probably won’t help most of you.

Inland Valleys IPA – Fax in your W9 to (213) 830-1815, Attn: Inland Valleys IPA

ProMed/Upland Medical Group – Even if you have more than one IPA contract with a group that ProMed administers, one fax will update everything. So, fax the W9 to (714) 667-8156, Attn: ProMed

United HealthCare – You can either fax or email the update. The email is phshpdemo@uhc.com and the fax is (855) 314-6844

I have also included all this information in beautiful spreadsheet form. Here is the Health plan updates spreadsheet.

You’re welcome  🙂

As always, if you have any questions or anything to add, email or comment.

 

 

 

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Filed under Billing, Doctor's Office, Medical Billing, Office policy

NDC Numbers

So, I just learned something today. About NDC numbers. 

When the NDC number from the label of our medication was not 11 digits, I would add a zero in front of the NDC number when I set up the codes in my system. Recently, I have been having issues with Blue Cross and the NDC for Avastin; they keep sending me rejections stating the NDC is not correct. I checked and double checked on the label of the bottle of medication in the doctor’s fridge that the NDC number I used was correct. A couple of LOOONNNG, irritating phone calls with Blue Cross and some judicious Googling later, I have found the answer. 

The zero does not always go in front of the number. Sometimes it goes in the middle of the number and sometimes it goes at the end-ish of the number. And yes, sometimes we have to add one in front. It depends on how the digits of the NDC number are grouped and where the dashes are placed. Here is the breakdown:

10-digit format:                              Add zero  

4 digits-4 digits-2 digits           1st position – Example: 01111-2222-33       Example: 1111-2222-33

5 digits-3 digits-2 digits           6th position – Example: 99999-0888-77  Example: 99999-888-77

5 digits-4 digits-1 digits            10th position – Example: 44444-5555-01  Example: 44444-5555-1 

Here is our real world example. My NDC number for Avastin is 50242-060-01. I had been sending it to Blue Cross with the zero in front. But the correct format is 50242006001. Please remember, most clearinghouses will reject an NDC number if you put the dashes in. I am refiling so, so, so many Avastins to Blue Cross now. Wish me luck. 

 

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Why you are out of network for Covered CA

I have two providers who are both out of network for the Blue Shield Covered CA Silver plan. They were both surprised and displeased by this. And so were their patients. As a result, I was tasked with “looking into this, please.” Which, as an aside, I was happy to do, seeing as it is my job.

So, it turns out, the first provider was out of network with the Blue Shield Covered CA Silver plan because in late 2013 when he was sent the application for the three tiers of Covered CA plans, he chose to sign up with only the platinum and gold plans, and specifically opted out of the silver plan. Then he promptly forgot that he signed that paper and in Jan 2014 when he started seeing Covered CA people, Blue Shield told Silver patients that he was a provider. They came to him and he saw them and then they had 50% coinsurances applied to every visit. And no one was happy.

Since I learned my lesson with that situation, when it came time to contract the second doctor in this story with Blue Shield, I MADE SURE to check all three boxes for all three tiers of the Covered CA plans. So, at the end of 2014 when he started seeing Covered CA people, Blue Shield told Silver patients that he was a provider. They came to him and he saw them and then they had 50% coinsurances applied. When I called Blue Shield with a copy of the application in my hand the provider enrollment representative told me that since the HOSPITAL my doctor had rights in was not contracted with the Blue Shield Covered CA Silver plan, Blue Shield could not give him a contract that included that plan.

So, if you are having issues with large deductibles, large coinsurances, and your claims are being processed as out of network, call provider enrollment. The issue is probably either something that seemed insignificant and has been forgotten, or completely out of your hands, and something the doctor needs to address.

The contact info for Blue Shield provider enrollment is (800) 258-3091 or BSCproviderinfo@blueshieldca.com

 

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Filed under Billing, Blue Shield, Contracting, Medical Billing

Public service announcement on immunizations

There is only one immunization ICD10 code now. The code is Z23. The description of the code is “encounter for immunization.” You no longer have to specify what vaccine or whether it is oral or intramuscular in the diagnosis code.

For those of you using keywords to search, I am here to help. For my subscribed readers, sorry if this seems repetitive. When searching for the ICD10 replacement for a specific ICD9, your search engine will pick up the terms from this post and you will be able to find what you need in a way that wouldn’t be available with just the new code.

If you are billing a flu shot, use Z23

If you are billing a pneumo, use Z23

If you are billing Hep A or B, use Z23

If you are billing DTap, TDaP, Tetanus alone, or DT, use Z23

If you are billing polio, MMR, varicella, or Hib, use Z23

If you are billing HPV or meningococcal, use Z23

As always, if you have questions or have suggestions, call (909) 374-5439 or email newgenerationbilling@gmail.com, or both. 

 

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Online Class Schedule

If you’ve checked out our pricing and information page, you know we have online classes available for $30 per class. In the past, I was having people call me to get the schedule, but as it turns out, that is really annoying for you guys. You would like to know why I can’t just post it on the blog. You make a very good point. So, here is the schedule for the next three months.

Date                                                                              Topic

February 5th           Billing Blue Cross/Blue Shield out of state plans in CA

February 19th          Common medical terminology and basics of billing

March 4th                 Medical necessity – What it is and why you care about it

March 18th               The global period and modifiers 24, 78, and 79

April 1st                     Reports to manage the health of your practice

April 15th                  Tips and tools for your front desk

Space is limited. Each class has spaces for 10 people so that everyone can get a chance to participate in the question and answer portion of the lesson. Please call (909) 374-2581 to reserve your spot. 

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Filed under Medical Billing, Online classes

96372 for Inpatient Injections

This one is quick and short.

I have been getting a lot of email questions about whether or not 96372 can be used for inpatient billing. Here is the exact text of the description of 96372 from the CPT book:

Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

The description itself does not specify a location, so I have billed it for many different settings, and I have never had a problem. Here are the notes included with the description

Do not report 96372 for injections given without direct physician or other qualified health care professional supervision. To report, use 99211. Hospitals may report 96372 when the physician or other qualified health care professional is not present.

Happy holidays!

 

 

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Filed under 96372, Administrations, Billing, Inpatient, Medical Billing