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Re: [MedicalBillers] Re: URGENT CARE VISIT

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  • Erika Dennis
    Hi, That s a little vague...what did the denial say on the remittance advice? It could be many reasons...   Erika D. Mid Ohio Pulmonary & Sleep Assoc, Inc.
    Message 1 of 16 , Feb 1, 2010
      Hi,
      That's a little vague...what did the denial say on the remittance advice? It could be many reasons...
       
      Erika D.
      Mid Ohio Pulmonary & Sleep Assoc, Inc.



      --- On Sat, 1/30/10, fami tab <marmar623@...> wrote:


      From: fami tab <marmar623@...>
      Subject: [MedicalBillers] Re: URGENT CARE VISIT
      To: MedicalBillers@yahoogroups.com
      Date: Saturday, January 30, 2010, 10:12 PM


       



      Hello Everyone,

      Question: my friend billed insurance with the urgent care cpt code. All of their claim was rejected, no payment was received,
      Any advised?
      Appreciated,
      Thanks,

      Urgent Care Office Visit 99058

      ____________ _________ _________ __
      From: Carol Roush <carollroush@ yahoo.com>
      To: MedicalBillers@ yahoogroups. com
      Sent: Fri, January 29, 2010 4:56:09 PM
      Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

      the CPT code we use to bill speech therapy is 92507.

      --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:

      From: Corri Baker <virtuous_gracious@ yahoo.com>
      Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
      To: MedicalBillers@ yahoogroups. com
      Date: Friday, January 29, 2010, 4:20 PM

      I understand that, I've worked at a few places like that. Check CMS or google RVU 2010. I'd also be more than happy to help you if you can't find them, take down my email and email me with questions or specific codes you need RVU's for.

      Happy Weekend,

      Corri

      ____________ _________ _________ __

      From: Carol Roush <carollroush@ yahoo.com>

      To: MedicalBillers@ yahoogroups. com

      Sent: Fri, January 29, 2010 4:10:58 PM

      Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

      Unfortunately, my boss doesn't buy any books. We just do how she says to calculate the co-insurance. It's unclear to me and I don't want to ask her for she is not a patient person.

      Thanks for the help,

      Carol

      --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:

      From: Corri Baker <virtuous_gracious@ yahoo.com>

      Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

      To: MedicalBillers@ yahoogroups. com

      Date: Friday, January 29, 2010, 3:47 PM

      Also some carriers are now offering on their website for providers to go in and calculate how much they'll get paid and how much the patient will owe. I've seen more and more carriers here in my area offering that as a "perk." So you may check online with some carriers to see if they offer that tool.

      ____________ _________ _________ __

      From: Corri Baker <virtuous_gracious@ yahoo.com>

      To: MedicalBillers@ yahoogroups. com

      Sent: Fri, January 29, 2010 3:43:20 PM

      Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

      what CPT code? each CPT code has an RVU (relative value unit) attached to it. You may ask your boss to buy you the RVU book (it's a easy simple way to find the values.) The RVU is how the insurance company pays you. Your contract rate is set in your contract, but the RVU's change. So when your claim goes in, you're paid according to your contract $56 an RVU. So however many RVU's that CPT is, you're contract tells them how much to pay. Clear or clear as mud? :)

      ____________ _________ _________ __

      From: Carol Roush <carollroush@ yahoo.com>

      To: MedicalBillers@ yahoogroups. com

      Sent: Fri, January 29, 2010 3:38:50 PM

      Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

      I'm not sure what an RVU is. I just know that we bill $79 as our fee to the insurance. Then, our contracted rate is 56.00 for Aetna.

      --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:

      From: Corri Baker <virtuous_gracious@ yahoo.com>

      Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

      To: MedicalBillers@ yahoogroups. com

      Date: Friday, January 29, 2010, 3:03 PM

      Hi Carol,

      I'm confused. You're saying your contract rate is $56.00 an RVU? If this is the case then you'll have to get the RVU for the code you're billing, then you multiply the RVU by $56 to get the price you'll be paid by the insurance. Once you know what you'll be paid you can easily figure out the 10% the patient will owe just multiply it by 0.10.

      I hope I didn't misunderstand you,

      Corri :)

      ____________ _________ _________ __

      From: Carol Roush <carollroush@ yahoo.com>

      To: MedicalBillers@ yahoogroups. com

      Sent: Fri, January 29, 2010 2:51:13 PM

      Subject: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

      Hello,

      I have a new task at my job. The way my manager explained it is quite confusing.

      So let's say the deductible is $250. The contracted rate is $56.00. After decuctible is met, co-insurance is 90/10%

      I went 56.00 x 4 = 224

      Can someone please explain the rest of the calculations to me after the $224 is calculated all the way to the 10% of the $56.00.

      I'd greatly appreciate it! Thanks!

      Carol

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      [Non-text portions of this message have been removed]
    • debbie brosnan
      In our state (Mi) depending on the carrier we bill this CPT code with a zero dollar amount then the appropiate level E/M all with a place of service 11. 
      Message 2 of 16 , Feb 1, 2010
        In our state (Mi) depending on the carrier we bill this CPT code with a zero dollar amount then the appropiate level E/M all with a place of service 11.  99058 is just identifing services rendered in urgent care setting.  Many payers dont even show this code as a payable service.  Blues use an "S" code with the E/M to identify services preformed in an urgent care setting.  Hope this helps.
         
        Deb

        --- On Mon, 2/1/10, Erika Dennis <rikaroo0081@...> wrote:


        From: Erika Dennis <rikaroo0081@...>
        Subject: Re: [MedicalBillers] Re: URGENT CARE VISIT
        To: MedicalBillers@yahoogroups.com
        Date: Monday, February 1, 2010, 10:53 AM


         



        Hi,
        That's a little vague...what did the denial say on the remittance advice? It could be many reasons...
         
        Erika D.
        Mid Ohio Pulmonary & Sleep Assoc, Inc.

        --- On Sat, 1/30/10, fami tab <marmar623@yahoo. com> wrote:

        From: fami tab <marmar623@yahoo. com>
        Subject: [MedicalBillers] Re: URGENT CARE VISIT
        To: MedicalBillers@ yahoogroups. com
        Date: Saturday, January 30, 2010, 10:12 PM

         

        Hello Everyone,

        Question: my friend billed insurance with the urgent care cpt code. All of their claim was rejected, no payment was received,
        Any advised?
        Appreciated,
        Thanks,

        Urgent Care Office Visit 99058

        ____________ _________ _________ __
        From: Carol Roush <carollroush@ yahoo.com>
        To: MedicalBillers@ yahoogroups. com
        Sent: Fri, January 29, 2010 4:56:09 PM
        Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

        the CPT code we use to bill speech therapy is 92507.

        --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:

        From: Corri Baker <virtuous_gracious@ yahoo.com>
        Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
        To: MedicalBillers@ yahoogroups. com
        Date: Friday, January 29, 2010, 4:20 PM

        I understand that, I've worked at a few places like that. Check CMS or google RVU 2010. I'd also be more than happy to help you if you can't find them, take down my email and email me with questions or specific codes you need RVU's for.

        Happy Weekend,

        Corri

        ____________ _________ _________ __

        From: Carol Roush <carollroush@ yahoo.com>

        To: MedicalBillers@ yahoogroups. com

        Sent: Fri, January 29, 2010 4:10:58 PM

        Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

        Unfortunately, my boss doesn't buy any books. We just do how she says to calculate the co-insurance. It's unclear to me and I don't want to ask her for she is not a patient person.

        Thanks for the help,

        Carol

        --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:

        From: Corri Baker <virtuous_gracious@ yahoo.com>

        Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

        To: MedicalBillers@ yahoogroups. com

        Date: Friday, January 29, 2010, 3:47 PM

        Also some carriers are now offering on their website for providers to go in and calculate how much they'll get paid and how much the patient will owe. I've seen more and more carriers here in my area offering that as a "perk." So you may check online with some carriers to see if they offer that tool.

        ____________ _________ _________ __

        From: Corri Baker <virtuous_gracious@ yahoo.com>

        To: MedicalBillers@ yahoogroups. com

        Sent: Fri, January 29, 2010 3:43:20 PM

        Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

        what CPT code? each CPT code has an RVU (relative value unit) attached to it. You may ask your boss to buy you the RVU book (it's a easy simple way to find the values.) The RVU is how the insurance company pays you. Your contract rate is set in your contract, but the RVU's change. So when your claim goes in, you're paid according to your contract $56 an RVU. So however many RVU's that CPT is, you're contract tells them how much to pay. Clear or clear as mud? :)

        ____________ _________ _________ __

        From: Carol Roush <carollroush@ yahoo.com>

        To: MedicalBillers@ yahoogroups. com

        Sent: Fri, January 29, 2010 3:38:50 PM

        Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

        I'm not sure what an RVU is. I just know that we bill $79 as our fee to the insurance. Then, our contracted rate is 56.00 for Aetna.

        --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:

        From: Corri Baker <virtuous_gracious@ yahoo.com>

        Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

        To: MedicalBillers@ yahoogroups. com

        Date: Friday, January 29, 2010, 3:03 PM

        Hi Carol,

        I'm confused. You're saying your contract rate is $56.00 an RVU? If this is the case then you'll have to get the RVU for the code you're billing, then you multiply the RVU by $56 to get the price you'll be paid by the insurance. Once you know what you'll be paid you can easily figure out the 10% the patient will owe just multiply it by 0.10.

        I hope I didn't misunderstand you,

        Corri :)

        ____________ _________ _________ __

        From: Carol Roush <carollroush@ yahoo.com>

        To: MedicalBillers@ yahoogroups. com

        Sent: Fri, January 29, 2010 2:51:13 PM

        Subject: [MedicalBillers] Can I get help with calculating co-insurance and deductibles

        Hello,

        I have a new task at my job. The way my manager explained it is quite confusing.

        So let's say the deductible is $250. The contracted rate is $56.00. After decuctible is met, co-insurance is 90/10%

        I went 56.00 x 4 = 224

        Can someone please explain the rest of the calculations to me after the $224 is calculated all the way to the 10% of the $56.00.

        I'd greatly appreciate it! Thanks!

        Carol

        [Non-text portions of this message have been removed]

        [Non-text portions of this message have been removed]

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      • Melinda
        Here s where you find RVUs. http://www.cms.hhs.gov/PhysicianFeeSched/PFSCSF/list.asp#TopOfPage Melinda Brown, CMBS Ins Biller
        Message 3 of 16 , Feb 1, 2010
          Here's where you find RVUs.
          http://www.cms.hhs.gov/PhysicianFeeSched/PFSCSF/list.asp#TopOfPage

          Melinda Brown, CMBS
          Ins Biller

          --- In MedicalBillers@yahoogroups.com, Corri Baker <virtuous_gracious@...> wrote:
          >
          > I understand that, I've worked at a few places like that. Check CMS or google RVU 2010. I'd also be more than happy to help you if you can't find them, take down my email and email me with questions or specific codes you need RVU's for.
          >
          > Happy Weekend,
          > Corri
          >
          >
          >
          >
          > ________________________________
          > From: Carol Roush <carollroush@...>
          > To: MedicalBillers@yahoogroups.com
          > Sent: Fri, January 29, 2010 4:10:58 PM
          > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
          >
          >
          > Unfortunately, my boss doesn't buy any books. We just do how she says to calculate the co-insurance. It's unclear to me and I don't want to ask her for she is not a patient person.
          >
          > Thanks for the help,
          >
          > Carol
          >
          > --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
          >
          > From: Corri Baker <virtuous_gracious@ yahoo.com>
          > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
          > To: MedicalBillers@ yahoogroups. com
          > Date: Friday, January 29, 2010, 3:47 PM
          >
          >
          >
          > Also some carriers are now offering on their website for providers to go in and calculate how much they'll get paid and how much the patient will owe. I've seen more and more carriers here in my area offering that as a "perk." So you may check online with some carriers to see if they offer that tool.
          >
          > ____________ _________ _________ __
          >
          > From: Corri Baker <virtuous_gracious@ yahoo.com>
          >
          > To: MedicalBillers@ yahoogroups. com
          >
          > Sent: Fri, January 29, 2010 3:43:20 PM
          >
          > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
          >
          > what CPT code? each CPT code has an RVU (relative value unit) attached to it. You may ask your boss to buy you the RVU book (it's a easy simple way to find the values.) The RVU is how the insurance company pays you. Your contract rate is set in your contract, but the RVU's change. So when your claim goes in, you're paid according to your contract $56 an RVU. So however many RVU's that CPT is, you're contract tells them how much to pay. Clear or clear as mud? :)
          >
          > ____________ _________ _________ __
          >
          > From: Carol Roush <carollroush@ yahoo.com>
          >
          > To: MedicalBillers@ yahoogroups. com
          >
          > Sent: Fri, January 29, 2010 3:38:50 PM
          >
          > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
          >
          > I'm not sure what an RVU is. I just know that we bill $79 as our fee to the insurance. Then, our contracted rate is 56.00 for Aetna.
          >
          > --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
          >
          > From: Corri Baker <virtuous_gracious@ yahoo.com>
          >
          > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
          >
          > To: MedicalBillers@ yahoogroups. com
          >
          > Date: Friday, January 29, 2010, 3:03 PM
          >
          > Hi Carol,
          >
          > I'm confused. You're saying your contract rate is $56.00 an RVU? If this is the case then you'll have to get the RVU for the code you're billing, then you multiply the RVU by $56 to get the price you'll be paid by the insurance. Once you know what you'll be paid you can easily figure out the 10% the patient will owe just multiply it by 0.10.
          >
          > I hope I didn't misunderstand you,
          >
          > Corri :)
          >
          > ____________ _________ _________ __
          >
          > From: Carol Roush <carollroush@ yahoo.com>
          >
          > To: MedicalBillers@ yahoogroups. com
          >
          > Sent: Fri, January 29, 2010 2:51:13 PM
          >
          > Subject: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
          >
          > Hello,
          >
          > I have a new task at my job. The way my manager explained it is quite confusing.
          >
          > So let's say the deductible is $250. The contracted rate is $56.00. After decuctible is met, co-insurance is 90/10%
          >
          > I went 56.00 x 4 = 224
          >
          > Can someone please explain the rest of the calculations to me after the $224 is calculated all the way to the 10% of the $56.00.
          >
          > I'd greatly appreciate it! Thanks!
          >
          > Carol
          >
          > [Non-text portions of this message have been removed]
          >
          > [Non-text portions of this message have been removed]
          >
          > [Non-text portions of this message have been removed]
          >
          > [Non-text portions of this message have been removed]
          >
          > [Non-text portions of this message have been removed]
          >
          > [Non-text portions of this message have been removed]
          >
          >
          >
          >
          >
          >
          >
          > [Non-text portions of this message have been removed]
          >
        • Melinda
          It must be billed in addition to basic service (other E/M, CPT, etc.). It cannot be billed alone. Check out your CPT code book for exact language. Hope that
          Message 4 of 16 , Feb 1, 2010
            It must be billed "in addition to basic service" (other E/M, CPT, etc.). It cannot be billed alone. Check out your CPT code book for exact language.

            Hope that helps!

            Melinda Brown, CMBS
            Ins Biller

            --- In MedicalBillers@yahoogroups.com, fami tab <marmar623@...> wrote:
            >
            > Hello Everyone,
            >
            > Question: my friend billed insurance with the urgent care cpt code. All of their claim was rejected, no payment was received,
            > Any advised?
            > Appreciated,
            > Thanks,
            >
            > Urgent Care Office Visit 99058
            >
            >
            >
            >
            > ________________________________
            > From: Carol Roush <carollroush@...>
            > To: MedicalBillers@yahoogroups.com
            > Sent: Fri, January 29, 2010 4:56:09 PM
            > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
            >
            >
            > the CPT code we use to bill speech therapy is 92507.
            >
            > --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
            >
            > From: Corri Baker <virtuous_gracious@ yahoo.com>
            > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
            > To: MedicalBillers@ yahoogroups. com
            > Date: Friday, January 29, 2010, 4:20 PM
            >
            >
            >
            > I understand that, I've worked at a few places like that. Check CMS or google RVU 2010. I'd also be more than happy to help you if you can't find them, take down my email and email me with questions or specific codes you need RVU's for.
            >
            > Happy Weekend,
            >
            > Corri
            >
            > ____________ _________ _________ __
            >
            > From: Carol Roush <carollroush@ yahoo.com>
            >
            > To: MedicalBillers@ yahoogroups. com
            >
            > Sent: Fri, January 29, 2010 4:10:58 PM
            >
            > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
            >
            > Unfortunately, my boss doesn't buy any books. We just do how she says to calculate the co-insurance. It's unclear to me and I don't want to ask her for she is not a patient person.
            >
            > Thanks for the help,
            >
            > Carol
            >
            > --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
            >
            > From: Corri Baker <virtuous_gracious@ yahoo.com>
            >
            > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
            >
            > To: MedicalBillers@ yahoogroups. com
            >
            > Date: Friday, January 29, 2010, 3:47 PM
            >
            > Also some carriers are now offering on their website for providers to go in and calculate how much they'll get paid and how much the patient will owe. I've seen more and more carriers here in my area offering that as a "perk." So you may check online with some carriers to see if they offer that tool.
            >
            > ____________ _________ _________ __
            >
            > From: Corri Baker <virtuous_gracious@ yahoo.com>
            >
            > To: MedicalBillers@ yahoogroups. com
            >
            > Sent: Fri, January 29, 2010 3:43:20 PM
            >
            > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
            >
            > what CPT code? each CPT code has an RVU (relative value unit) attached to it. You may ask your boss to buy you the RVU book (it's a easy simple way to find the values.) The RVU is how the insurance company pays you. Your contract rate is set in your contract, but the RVU's change. So when your claim goes in, you're paid according to your contract $56 an RVU. So however many RVU's that CPT is, you're contract tells them how much to pay. Clear or clear as mud? :)
            >
            > ____________ _________ _________ __
            >
            > From: Carol Roush <carollroush@ yahoo.com>
            >
            > To: MedicalBillers@ yahoogroups. com
            >
            > Sent: Fri, January 29, 2010 3:38:50 PM
            >
            > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
            >
            > I'm not sure what an RVU is. I just know that we bill $79 as our fee to the insurance. Then, our contracted rate is 56.00 for Aetna.
            >
            > --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
            >
            > From: Corri Baker <virtuous_gracious@ yahoo.com>
            >
            > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
            >
            > To: MedicalBillers@ yahoogroups. com
            >
            > Date: Friday, January 29, 2010, 3:03 PM
            >
            > Hi Carol,
            >
            > I'm confused. You're saying your contract rate is $56.00 an RVU? If this is the case then you'll have to get the RVU for the code you're billing, then you multiply the RVU by $56 to get the price you'll be paid by the insurance. Once you know what you'll be paid you can easily figure out the 10% the patient will owe just multiply it by 0.10.
            >
            > I hope I didn't misunderstand you,
            >
            > Corri :)
            >
            > ____________ _________ _________ __
            >
            > From: Carol Roush <carollroush@ yahoo.com>
            >
            > To: MedicalBillers@ yahoogroups. com
            >
            > Sent: Fri, January 29, 2010 2:51:13 PM
            >
            > Subject: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
            >
            > Hello,
            >
            > I have a new task at my job. The way my manager explained it is quite confusing.
            >
            > So let's say the deductible is $250. The contracted rate is $56.00. After decuctible is met, co-insurance is 90/10%
            >
            > I went 56.00 x 4 = 224
            >
            > Can someone please explain the rest of the calculations to me after the $224 is calculated all the way to the 10% of the $56.00.
            >
            > I'd greatly appreciate it! Thanks!
            >
            > Carol
            >
            > [Non-text portions of this message have been removed]
            >
            > [Non-text portions of this message have been removed]
            >
            > [Non-text portions of this message have been removed]
            >
            > [Non-text portions of this message have been removed]
            >
            > [Non-text portions of this message have been removed]
            >
            > [Non-text portions of this message have been removed]
            >
            > [Non-text portions of this message have been removed]
            >
            > [Non-text portions of this message have been removed]
            >
            >
            >
            >
            >
            >
            >
            > [Non-text portions of this message have been removed]
            >
          • djgeisel
            To take off on this...the fifth visit will have $26 left to the deductible so collect $26 plus the remaining amount of $30 you charge 10% which is 3.00 so all
            Message 5 of 16 , Feb 1, 2010
              To take off on this...the fifth visit will have $26 left to the deductible so collect $26 plus the remaining amount of $30 you charge 10% which is 3.00 so all together on the 5th visit charge the patient 29.00.($26.00 + $3.00) On the next visit $5.60 is 10% of the approved amount and that is of course what you would collect since now the deductible is met.
              Diana


              --- In MedicalBillers@yahoogroups.com, fami tab <marmar623@...> wrote:
              >
              > Good evening Everyone,
              > Please correct me if I am wrong.
              >
              >
              >
              >
              > Contract rate is $56.00
              > 90% of 56 is $50.40
              > 10% of 56 $5.60
              >
              > 250 divided by 50.40 is 4.96, almost 5, the first 5 visits are going towards deductable.
              >
              > Fami
              >
              >
              >
              > ________________________________
              > From: Carol Roush <carollroush@...>
              > To: MedicalBillers@yahoogroups.com
              > Sent: Fri, January 29, 2010 4:56:09 PM
              > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
              >
              >
              > the CPT code we use to bill speech therapy is 92507.
              >
              > --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
              >
              > From: Corri Baker <virtuous_gracious@ yahoo.com>
              > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
              > To: MedicalBillers@ yahoogroups. com
              > Date: Friday, January 29, 2010, 4:20 PM
              >
              >
              >
              > I understand that, I've worked at a few places like that. Check CMS or google RVU 2010. I'd also be more than happy to help you if you can't find them, take down my email and email me with questions or specific codes you need RVU's for.
              >
              > Happy Weekend,
              >
              > Corri
              >
              > ____________ _________ _________ __
              >
              > From: Carol Roush <carollroush@ yahoo.com>
              >
              > To: MedicalBillers@ yahoogroups. com
              >
              > Sent: Fri, January 29, 2010 4:10:58 PM
              >
              > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
              >
              > Unfortunately, my boss doesn't buy any books. We just do how she says to calculate the co-insurance. It's unclear to me and I don't want to ask her for she is not a patient person.
              >
              > Thanks for the help,
              >
              > Carol
              >
              > --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
              >
              > From: Corri Baker <virtuous_gracious@ yahoo.com>
              >
              > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
              >
              > To: MedicalBillers@ yahoogroups. com
              >
              > Date: Friday, January 29, 2010, 3:47 PM
              >
              > Also some carriers are now offering on their website for providers to go in and calculate how much they'll get paid and how much the patient will owe. I've seen more and more carriers here in my area offering that as a "perk." So you may check online with some carriers to see if they offer that tool.
              >
              > ____________ _________ _________ __
              >
              > From: Corri Baker <virtuous_gracious@ yahoo.com>
              >
              > To: MedicalBillers@ yahoogroups. com
              >
              > Sent: Fri, January 29, 2010 3:43:20 PM
              >
              > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
              >
              > what CPT code? each CPT code has an RVU (relative value unit) attached to it. You may ask your boss to buy you the RVU book (it's a easy simple way to find the values.) The RVU is how the insurance company pays you. Your contract rate is set in your contract, but the RVU's change. So when your claim goes in, you're paid according to your contract $56 an RVU. So however many RVU's that CPT is, you're contract tells them how much to pay. Clear or clear as mud? :)
              >
              > ____________ _________ _________ __
              >
              > From: Carol Roush <carollroush@ yahoo.com>
              >
              > To: MedicalBillers@ yahoogroups. com
              >
              > Sent: Fri, January 29, 2010 3:38:50 PM
              >
              > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
              >
              > I'm not sure what an RVU is. I just know that we bill $79 as our fee to the insurance. Then, our contracted rate is 56.00 for Aetna.
              >
              > --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
              >
              > From: Corri Baker <virtuous_gracious@ yahoo.com>
              >
              > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
              >
              > To: MedicalBillers@ yahoogroups. com
              >
              > Date: Friday, January 29, 2010, 3:03 PM
              >
              > Hi Carol,
              >
              > I'm confused. You're saying your contract rate is $56.00 an RVU? If this is the case then you'll have to get the RVU for the code you're billing, then you multiply the RVU by $56 to get the price you'll be paid by the insurance. Once you know what you'll be paid you can easily figure out the 10% the patient will owe just multiply it by 0.10.
              >
              > I hope I didn't misunderstand you,
              >
              > Corri :)
              >
              > ____________ _________ _________ __
              >
              > From: Carol Roush <carollroush@ yahoo.com>
              >
              > To: MedicalBillers@ yahoogroups. com
              >
              > Sent: Fri, January 29, 2010 2:51:13 PM
              >
              > Subject: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
              >
              > Hello,
              >
              > I have a new task at my job. The way my manager explained it is quite confusing.
              >
              > So let's say the deductible is $250. The contracted rate is $56.00. After decuctible is met, co-insurance is 90/10%
              >
              > I went 56.00 x 4 = 224
              >
              > Can someone please explain the rest of the calculations to me after the $224 is calculated all the way to the 10% of the $56.00.
              >
              > I'd greatly appreciate it! Thanks!
              >
              > Carol
              >
              > [Non-text portions of this message have been removed]
              >
              > [Non-text portions of this message have been removed]
              >
              > [Non-text portions of this message have been removed]
              >
              > [Non-text portions of this message have been removed]
              >
              > [Non-text portions of this message have been removed]
              >
              > [Non-text portions of this message have been removed]
              >
              > [Non-text portions of this message have been removed]
              >
              > [Non-text portions of this message have been removed]
              >
              >
              >
              >
              >
              >
              >
              > [Non-text portions of this message have been removed]
              >
            • fami tab
              Thanks, Yes, that will help. Fami ________________________________ From: Melinda To: MedicalBillers@yahoogroups.com Sent: Mon,
              Message 6 of 16 , Feb 1, 2010
                Thanks, Yes, that will help.
                Fami



                ________________________________
                From: Melinda <melindadocsmith@...>
                To: MedicalBillers@yahoogroups.com
                Sent: Mon, February 1, 2010 12:46:57 PM
                Subject: [MedicalBillers] Re: URGENT CARE VISIT


                It must be billed "in addition to basic service" (other E/M, CPT, etc.). It cannot be billed alone. Check out your CPT code book for exact language.

                Hope that helps!

                Melinda Brown, CMBS
                Ins Biller

                --- In MedicalBillers@ yahoogroups. com, fami tab <marmar623@. ..> wrote:
                >
                > Hello Everyone,
                >
                > Question: my friend billed insurance with the urgent care cpt code. All of their claim was rejected, no payment was received,
                > Any advised?
                > Appreciated,
                > Thanks,
                >
                > Urgent Care Office Visit 99058
                >
                >
                >
                >
                > ____________ _________ _________ __
                > From: Carol Roush <carollroush@ ...>
                > To: MedicalBillers@ yahoogroups. com
                > Sent: Fri, January 29, 2010 4:56:09 PM
                > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
                >
                >
                > the CPT code we use to bill speech therapy is 92507.
                >
                > --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
                >
                > From: Corri Baker <virtuous_gracious@ yahoo.com>
                > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
                > To: MedicalBillers@ yahoogroups. com
                > Date: Friday, January 29, 2010, 4:20 PM
                >
                >
                >
                > I understand that, I've worked at a few places like that. Check CMS or google RVU 2010. I'd also be more than happy to help you if you can't find them, take down my email and email me with questions or specific codes you need RVU's for.
                >
                > Happy Weekend,
                >
                > Corri
                >
                > ____________ _________ _________ __
                >
                > From: Carol Roush <carollroush@ yahoo.com>
                >
                > To: MedicalBillers@ yahoogroups. com
                >
                > Sent: Fri, January 29, 2010 4:10:58 PM
                >
                > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
                >
                > Unfortunately, my boss doesn't buy any books. We just do how she says to calculate the co-insurance. It's unclear to me and I don't want to ask her for she is not a patient person.
                >
                > Thanks for the help,
                >
                > Carol
                >
                > --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
                >
                > From: Corri Baker <virtuous_gracious@ yahoo.com>
                >
                > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
                >
                > To: MedicalBillers@ yahoogroups. com
                >
                > Date: Friday, January 29, 2010, 3:47 PM
                >
                > Also some carriers are now offering on their website for providers to go in and calculate how much they'll get paid and how much the patient will owe. I've seen more and more carriers here in my area offering that as a "perk." So you may check online with some carriers to see if they offer that tool.
                >
                > ____________ _________ _________ __
                >
                > From: Corri Baker <virtuous_gracious@ yahoo.com>
                >
                > To: MedicalBillers@ yahoogroups. com
                >
                > Sent: Fri, January 29, 2010 3:43:20 PM
                >
                > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
                >
                > what CPT code? each CPT code has an RVU (relative value unit) attached to it. You may ask your boss to buy you the RVU book (it's a easy simple way to find the values.) The RVU is how the insurance company pays you. Your contract rate is set in your contract, but the RVU's change. So when your claim goes in, you're paid according to your contract $56 an RVU. So however many RVU's that CPT is, you're contract tells them how much to pay. Clear or clear as mud? :)
                >
                > ____________ _________ _________ __
                >
                > From: Carol Roush <carollroush@ yahoo.com>
                >
                > To: MedicalBillers@ yahoogroups. com
                >
                > Sent: Fri, January 29, 2010 3:38:50 PM
                >
                > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
                >
                > I'm not sure what an RVU is. I just know that we bill $79 as our fee to the insurance. Then, our contracted rate is 56.00 for Aetna.
                >
                > --- On Fri, 1/29/10, Corri Baker <virtuous_gracious@ yahoo.com> wrote:
                >
                > From: Corri Baker <virtuous_gracious@ yahoo.com>
                >
                > Subject: Re: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
                >
                > To: MedicalBillers@ yahoogroups. com
                >
                > Date: Friday, January 29, 2010, 3:03 PM
                >
                > Hi Carol,
                >
                > I'm confused. You're saying your contract rate is $56.00 an RVU? If this is the case then you'll have to get the RVU for the code you're billing, then you multiply the RVU by $56 to get the price you'll be paid by the insurance. Once you know what you'll be paid you can easily figure out the 10% the patient will owe just multiply it by 0.10.
                >
                > I hope I didn't misunderstand you,
                >
                > Corri :)
                >
                > ____________ _________ _________ __
                >
                > From: Carol Roush <carollroush@ yahoo.com>
                >
                > To: MedicalBillers@ yahoogroups. com
                >
                > Sent: Fri, January 29, 2010 2:51:13 PM
                >
                > Subject: [MedicalBillers] Can I get help with calculating co-insurance and deductibles
                >
                > Hello,
                >
                > I have a new task at my job. The way my manager explained it is quite confusing.
                >
                > So let's say the deductible is $250. The contracted rate is $56.00. After decuctible is met, co-insurance is 90/10%
                >
                > I went 56.00 x 4 = 224
                >
                > Can someone please explain the rest of the calculations to me after the $224 is calculated all the way to the 10% of the $56.00.
                >
                > I'd greatly appreciate it! Thanks!
                >
                > Carol
                >
                > [Non-text portions of this message have been removed]
                >
                > [Non-text portions of this message have been removed]
                >
                > [Non-text portions of this message have been removed]
                >
                > [Non-text portions of this message have been removed]
                >
                > [Non-text portions of this message have been removed]
                >
                > [Non-text portions of this message have been removed]
                >
                > [Non-text portions of this message have been removed]
                >
                > [Non-text portions of this message have been removed]
                >
                >
                >
                >
                >
                >
                >
                > [Non-text portions of this message have been removed]
                >







                [Non-text portions of this message have been removed]
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