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Re: Mod 77? - Help!

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  • Melinda
    I m still working on this issue. Going to try and see if there is a modifier to use, if not then I m appealing on the fact that the patient didn t disclose
    Message 1 of 13 , Dec 31, 2007
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      I'm still working on this issue. Going to try and see if there is a
      modifier to use, if not then I'm appealing on the fact that the
      patient didn't disclose this information to us, at the time of the
      appt. I'm hopeing Medicare will at least make the patient
      responsible to pay, even though we didn't receive a signed ABN. If
      that doesn't work, then I'm going to have the patient call Medicare
      and see what they can do.

      Thanks for everyone's help & feedback. I appreciate it.

      Melinda Brown, CMBS
      Ins Biller


      --- In MedicalBillers@yahoogroups.com, debbie brosnan
      <thebiller_2000@...> wrote:
      >
      > Linda,
      >
      > I agree with you. an ABN wouldn't have worked after the fact.
      Those rules are clear as to prior to services being rendered. I am
      afraid the 2nd Dr. is just out the money. Patients arent aware that
      only one visit per day for the same dx is payable. This is a too bad
      for the 2nd dr.
      >
      > Happy Holidays everyone.
      >
      > Deb
      >
      > Lin <italiandoll1967@...> wrote:
      > If you are going to appeal, I wouldn't appeal based on
      the fact you were
      > unaware of the other visit, Medicare will only pay one per day, and
      who ever
      > gets the claim in first is going to get paid, it makes no
      difference who's
      > visit was first. I'm not sure if you would win an appeal Unless you
      get the
      > patient involved since it was because of their "feeling" they did
      not
      > receive adequate care from Dr. X. Maybe as a first shot you could
      ask the
      > patient to contact Medicare. It's probably unlikely Dr. Y will want
      to
      > appeal based on a patient just preferring another opinion in the
      same day
      > for that diagnosis. It would have to be proven that Dr. X provided
      > inadequate care and doctors usually won't argue that one against
      each other,
      > plus they both gave the same diagnosis making it also a little
      trickier to
      > appeal.
      >
      > Also you might want to ask Medicare if the patient could be held
      > responsible, it wasn't known at the time your doctor seen him that
      he was
      > just at another office for the same thing so you couldn't really
      present him
      > with an ABN. ? I'm really not sure if this could be done after the
      fact.
      >
      > Linda Walker
      >
      > Practice Managers Resource & Networking Community
      > <http://www.billerswebsite.com> http://www.billerswebsite.com
      > A division of K&L Media, LLC
      > <http://www.klmediallc.com> http://www.klmediallc.com
      >
      > Website Design & Management for the Medical Services Industry
      >
      > From: MedicalBillers@yahoogroups.com
      [mailto:MedicalBillers@yahoogroups.com]
      > On Behalf Of Melinda
      > Sent: Friday, December 21, 2007 3:12 PM
      > To: MedicalBillers@yahoogroups.com
      > Subject: [MedicalBillers] Mod 77? - Help!
      >
      > Pt's visit to Medicare was denied for CO-B20 (pmt adjusted because
      > procedure/svc was fully paid to another provider). Pmt went to
      > another PCP. Pt was seen by two PCPs in the same day. His regular
      one
      > in the AM and my doctor in the afternoon. The doctors are in
      separate
      > practices, tax ids, etc.
      >
      > Is there any way to get this claim paid? I'm thinking I could use a
      > modifier 77; however, I'm not very familiar with using it.
      >
      > Here's the scenario: 12/20/07 - I spoke with John Doe. today and
      > asked if he had been into see Dr. X (Family Practice Physician) on
      > Oct. 11, 2007, which was the same day he came to see Dr. Y (my
      > doctor). He said "yes"; as he did not receive adequate treatment,
      > from Dr. X, and needed to do what he needed to, in order survive."
      >
      > He said that he had gone to Dr. X's office in the morning, after
      > being into Immediate Care over the weekend. He said they told him
      he
      > had shingles and when he went to Dr. X, as he was his primary care
      > physician, they didn't adequately treat him. His wife (Jane) is a
      > current patient of Dr. Y's and so he requested to see Dr. Y. We had
      > not seen John since 06/10/05 and didn't know he had another primary
      > care physician. Dr. Y diagnosed John with shingles on 10/11/07.
      >
      > Medicare has denied John's visit to Dr. Y, on 10/11/07, and said
      they
      > paid Dr. X and that Dr. Y's procedure was "fully furnished by
      another
      > provider."
      >
      > I contacted the biller, at Dr. X's office today and she told me
      John
      > was in at 9:45 AM on 10/11/07 and I had her fax me the chart note.
      > The patient was seen by Dr. Y at 3:10pm on 10/11/07. We did NOT
      know
      > that John had been seen by Dr. X. It wasn't documented in the chart
      > note.
      >
      > So do you think I could use the modifier 77 and provide chart notes
      > from both Dr. X and our office and hope they pay it? Any advice or
      > assistance would be much appreciated.
      >
      > Melinda Brown, CMBS
      > Ins Biller
      >
      > [Non-text portions of this message have been removed]
      >
      >
      >
      >
      >
      >
      > [Non-text portions of this message have been removed]
      >
    • Joktan Edison
      Wish you all very happy New Year!!!!!!!!!!!!!!!! Melinda, I would advise you to appeal the claim with all the medical documents or notes explaining it was
      Message 2 of 13 , Jan 1, 2008
      • 0 Attachment
        Wish you all very happy New Year!!!!!!!!!!!!!!!!


        Melinda, I would advise you to appeal the claim with
        all the medical documents or notes explaining it was
        necessary for the patient to have two E/m service a
        day and see what they do????

        Based on the feedback please involve the patient into
        the conversation and request them to push the
        insurance to pay this or else they have to pay this
        from their pocket.




        --- Melinda <melindadocsmith@...> wrote:

        > I'm still working on this issue. Going to try and
        > see if there is a
        > modifier to use, if not then I'm appealing on the
        > fact that the
        > patient didn't disclose this information to us, at
        > the time of the
        > appt. I'm hopeing Medicare will at least make the
        > patient
        > responsible to pay, even though we didn't receive a
        > signed ABN. If
        > that doesn't work, then I'm going to have the
        > patient call Medicare
        > and see what they can do.
        >
        > Thanks for everyone's help & feedback. I appreciate
        > it.
        >
        > Melinda Brown, CMBS
        > Ins Biller
        >
        >
        > --- In MedicalBillers@yahoogroups.com, debbie
        > brosnan
        > <thebiller_2000@...> wrote:
        > >
        > > Linda,
        > >
        > > I agree with you. an ABN wouldn't have worked
        > after the fact.
        > Those rules are clear as to prior to services being
        > rendered. I am
        > afraid the 2nd Dr. is just out the money. Patients
        > arent aware that
        > only one visit per day for the same dx is payable.
        > This is a too bad
        > for the 2nd dr.
        > >
        > > Happy Holidays everyone.
        > >
        > > Deb
        > >
        > > Lin <italiandoll1967@...> wrote:
        > > If you are going to appeal, I wouldn't
        > appeal based on
        > the fact you were
        > > unaware of the other visit, Medicare will only pay
        > one per day, and
        > who ever
        > > gets the claim in first is going to get paid, it
        > makes no
        > difference who's
        > > visit was first. I'm not sure if you would win an
        > appeal Unless you
        > get the
        > > patient involved since it was because of their
        > "feeling" they did
        > not
        > > receive adequate care from Dr. X. Maybe as a first
        > shot you could
        > ask the
        > > patient to contact Medicare. It's probably
        > unlikely Dr. Y will want
        > to
        > > appeal based on a patient just preferring another
        > opinion in the
        > same day
        > > for that diagnosis. It would have to be proven
        > that Dr. X provided
        > > inadequate care and doctors usually won't argue
        > that one against
        > each other,
        > > plus they both gave the same diagnosis making it
        > also a little
        > trickier to
        > > appeal.
        > >
        > > Also you might want to ask Medicare if the patient
        > could be held
        > > responsible, it wasn't known at the time your
        > doctor seen him that
        > he was
        > > just at another office for the same thing so you
        > couldn't really
        > present him
        > > with an ABN. ? I'm really not sure if this could
        > be done after the
        > fact.
        > >
        > > Linda Walker
        > >
        > > Practice Managers Resource & Networking Community
        > > <http://www.billerswebsite.com>
        > http://www.billerswebsite.com
        > > A division of K&L Media, LLC
        > > <http://www.klmediallc.com>
        > http://www.klmediallc.com
        > >
        > > Website Design & Management for the Medical
        > Services Industry
        > >
        > > From: MedicalBillers@yahoogroups.com
        > [mailto:MedicalBillers@yahoogroups.com]
        > > On Behalf Of Melinda
        > > Sent: Friday, December 21, 2007 3:12 PM
        > > To: MedicalBillers@yahoogroups.com
        > > Subject: [MedicalBillers] Mod 77? - Help!
        > >
        > > Pt's visit to Medicare was denied for CO-B20 (pmt
        > adjusted because
        > > procedure/svc was fully paid to another provider).
        > Pmt went to
        > > another PCP. Pt was seen by two PCPs in the same
        > day. His regular
        > one
        > > in the AM and my doctor in the afternoon. The
        > doctors are in
        > separate
        > > practices, tax ids, etc.
        > >
        > > Is there any way to get this claim paid? I'm
        > thinking I could use a
        > > modifier 77; however, I'm not very familiar with
        > using it.
        > >
        > > Here's the scenario: 12/20/07 - I spoke with John
        > Doe. today and
        > > asked if he had been into see Dr. X (Family
        > Practice Physician) on
        > > Oct. 11, 2007, which was the same day he came to
        > see Dr. Y (my
        > > doctor). He said "yes"; as he did not receive
        > adequate treatment,
        > > from Dr. X, and needed to do what he needed to, in
        > order survive."
        > >
        > > He said that he had gone to Dr. X's office in the
        > morning, after
        > > being into Immediate Care over the weekend. He
        > said they told him
        > he
        > > had shingles and when he went to Dr. X, as he was
        > his primary care
        > > physician, they didn't adequately treat him. His
        > wife (Jane) is a
        > > current patient of Dr. Y's and so he requested to
        > see Dr. Y. We had
        > > not seen John since 06/10/05 and didn't know he
        > had another primary
        > > care physician. Dr. Y diagnosed John with shingles
        > on 10/11/07.
        > >
        > > Medicare has denied John's visit to Dr. Y, on
        > 10/11/07, and said
        > they
        > > paid Dr. X and that Dr. Y's procedure was "fully
        > furnished by
        > another
        > > provider."
        > >
        > > I contacted the biller, at Dr. X's office today
        > and she told me
        > John
        > > was in at 9:45 AM on 10/11/07 and I had her fax me
        > the chart note.
        > > The patient was seen by Dr. Y at 3:10pm on
        > 10/11/07. We did NOT
        > know
        > > that John had been seen by Dr. X. It wasn't
        > documented in the chart
        > > note.
        > >
        > > So do you think I could use the modifier 77 and
        > provide chart notes
        > > from both Dr. X and our office and hope they pay
        > it? Any advice or
        > > assistance would be much appreciated.
        > >
        > > Melinda Brown, CMBS
        > > Ins Biller
        > >
        > > [Non-text portions of this message have been
        > removed]
        > >
        > >
        > >
        > >
        > >
        > >
        > > [Non-text portions of this message have been
        > removed]
        > >
        >
        >
        >






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