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Insurance

Medicare Patient with Secondary Insurance
Coding

Medicare Patient with Secondary Insurance

by Michael Warshaw, DPM, CPC

If a Medicare patient has a secondary, supplemental insurance that our practice does not participate with, how should this be handled?
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Coding

Bilateral Ulcer Debridement

by Dr. Michael Warshaw, DPM, CPC

“I have a patient that has bilateral ulcers with same depth on both feet, and I billed CPT 11042 -RT and CPT 11042 -LT, -59. Insurance has denied the second procedure as a duplicate. How else does this need to be billed as far bilateral ulcer procedures?”
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Practice Management

Having “Red White and Blue” Trouble?

by Cindy Pezza, PMAC

Here’s a fun fact that is wreaking havoc in practices with a large volume of patients over 65, especially where facility work (SNFs, assisted living, nursing homes) is involved: Enrollment in Medicare Advantage Plans has DOUBLED over the past decade It has been reported so far in 2021 that approximately 43% (up from 39% in 2020; see graph below) of the 63 million individuals who “have Medicare” actually receive their benefits via an Advantage Plan. And just when you thought you were finished updating patient insurance information in January and February, if those Medicare Advantage patients decide that the plan they chose was not the right fit and they want to go back to traditional Medicare, they have until March 31st to do so.
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Coding

Deleting A Claim

by Dr. Michael Warshaw, DPM, CPC

“If a patient refuses to pay their bill due to a high deductible, is it possible to request the insurance company (i.e. Anthem) to delete the claim? That way, the patient will still be responsible for paying their deductible amount elsewhere.”
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Coding

Denials for the Combination of CPT 28306 with CPT 28122

by Dr. Michael Warshaw, DPM, CPC

“We have had more than one claim where Blue Cross Blue Shield of Oklahoma is paying for CPT 28122 but denying CPT 28306, despite the use of the 59 modifier. Our question is why wouldn’t CPT 28306 be allowed instead of CPT 28122 as it is far more work? We are trying to determine how to appeal this.”
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Practice Management

Insurers Making Changes to Coverage due to COVID

by Dr. Michael Brody, DPM, CEO TLD Systems

As COVID numbers start an uptick, private insurers are making additional changes to their coverage policies.
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