This intel on filing medical billing claims is intended to help medical billing professionals and is not intended for patients or the general public. The medical biller has to ask the insurance company for a review many times over due to mistakes on our part, mistakes on the part of the insurance company or mistakes due to the patient having had multiple medical procedures and the insurance company mixes them up and denies all or both claims. Here are some of the common reasons a medical claim can be denied.
These are some of the billing items to watch out for to make sure that they are correct and fully filled out because if they are not the claim may not be paid. You must make sure that you have the correct current policy number, date of service, valid ICD9 (the medical billing code), name or the signature of the physician, the charges, the dates, valid CPT4, federal tax id and name, patient's name and date of birth, non covered dependent, and standard billing format (HCFA/UB92). The medical biller should write the account off if it is our error for filing the claim with the wrong identification number and the date of birth.
For pain management cases you would call the insurance carrier and ask to speak to the medical department. Most pain management claims need letters of medical necessity from the doctor.
For anesthesia bills give the insurance carrier the base code for the insurance code and then have the carrier reprocess for payment. You can print certain things on the claim such as the start time and end time of the procedure, the resubmission or corrected claim, modifiers, the base code and the number of units. When you are sending in a claim for a review write at the top of the claim, “please review this is the authorization number and this is the reference number. Corrected claim.” This statement has to be highlighted with a yellow highlighter marker. Don't appeal a claim if we weren't paid correctly just tell them to reprocess the claim.
This is what the insurance company writes when they send a claim back for a review by us. Will request someone review this claim. The provider is requesting payment.
When an account is not paid according to the Medicare fee schedule call the insurance carrier and send the claim back for a review and then send a print now note or the computer screen notes along with it.
Sometimes the patient will request the doctor to call him or her at home or at work and we must tell them that the doctor doesn't call anyone. For anesthesia medical claims you have to look in the crosswalk to get the base. For example you would use the procedure code of 01844 to get the base of 6 in the crosswalk book. Whenever you have procedure code 62318 with modifier 59 then claim should be paid. The insurance code 90784 is no longer used at GHI. W-9 forms to determine a patient’s social security number are sometimes rarely requested by the insurance carrier. For a Workman’s Compensation case you would always call the adjuster.
The way that you modify the HICFA 1500 form to include hospital billing for boilerplate stuff is as follows. On the HICFA put the hospital name, the hospital address and attention: the person's name.
Contact information for Brooklyn Anesthesia Reports is below.
Brooklyn Anesthesia Reports
Fax# 718-951-3074
Local 94 Benefit Fund
331-337 West 44th Street
New York, NY 10036
Contact Rita at 212-541-9880 extension 250
Fax 212-504-3292
Sometimes the patient needs an itemized bill to get a refund from their insurance carrier. You would simply ask someone with administrative computer access to print an itemized bill to send to the carrier.
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Contributor's Note
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