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Re: [MedicalBillers] AARP help

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  • Karen Vulgamore
    HI! Its not a crossover claim. Its a medicare/aarp hmo. The claims go directly to AARP (which is now owned by United). The NPI does match our office. The Dr
    Message 1 of 8 , Jun 23, 2010
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      HI!

      Its not a crossover claim. Its a medicare/aarp hmo. The claims go directly to AARP (which is now owned by United).
      The NPI does match our office. The Dr has an individual ID, but we dont use that.
      I was on the phone/email with a rep for 5 months- she couldnt figure it out and basically said 'good luck' and closed the case. I could have screamed!!
      Her final recommendation was to change the modifier to an acceptable Medicare code. I dont use straight medicare so I have no idea what to use other that AT for active treatment. What would you recommend??

      Thanks- Karen


      ________________________________
      From: Shannon Q <intotherosegarden@...>
      To: MedicalBillers@yahoogroups.com
      Sent: Wed, June 23, 2010 10:57:52 AM
      Subject: Re: [MedicalBillers] AARP help


      Wow, how frustrating!

      Does the NPI you use to bill Medicare match up with the one on file with AARP?

      We have had issues with crossover claims in the past when a provider uses an individual NPI for Medicare but gives the group NPI to the other carriers and vice versa. Not AARP specifically, but I would imagine it's possible.

      I can't say I've ever seen AARP make a determination based on the actual coding of the claim. They usually just go along with however Medicare processes. I have seen that denial when Medicare denies a claim and that denial crosses over. Am I understanding correctly that Medicare has paid the claims and that you are seeking reiumbursement from AARP for the coinsurance?
      Shannon Quinn
      A/R Manager
      Health Care Practice Management
      1602 Newport Gap Pike
      Wilmington, DE 19808
      302-633-5840 Ext 321
      302-633-5844 (fax)

      ________________________________
      From: healthygrl2008 <healthygrl2008@...>
      To: MedicalBillers@yahoogroups.com
      Sent: Wed, June 23, 2010 10:23:29 AM
      Subject: [MedicalBillers] AARP help


      Hi everyone...I rarely get on here....but it is always interesting to look thru the emails and see what I can learn. Thanks for being a help to me without even knowing it!!!

      My prob with AARP!!! uugh! I sent claims, EOB claims NPI is wrong, call AARP- NPI is fine, "please resubmit" Ok- so I resubmit with a copy of the EOB and my notes of who/when I called. The same claim comes back denied but this time because its not a Medicare covered serivce. There is only 1 CPT for a spinal adjustment (at each level). I call and point that out- they 'reprocess it" while I'm on the phone. 3wks later- same claims comes back denied again for NPI# being wrong....and around we go! I haven't actually gotten paid on them in almost a year. I even had a claims speicialst assigned to one patients file- they ultimately had me resubmit the claims 6 different times and in they end they claim my diagnosis codes weren't medicare compliant!!!
      Does that mean I should have used AT for active treatment instead of the numberical DX codes??

      Thanks for your help!!
      Karen

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    • Shannon Q
      I see. That s a completely different situation from what I imagined :) I would recommend looking at the LCD for your area. The LCD for MD, DE, PA, NJ and
      Message 2 of 8 , Jun 23, 2010
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        I see. That's a completely different situation from what I imagined :)

        I would recommend looking at the LCD for your area. The LCD for MD, DE, PA, NJ and DC is here:

        https://www.highmarkmedicareservices.com/policy/mac-ab/l27480-r4.html

        The LCD will tell you which diagnosis codes are covered.

        If you want to share your locataion and what diagnosis you are using, I might be able to help you sort it out.
         Shannon Quinn
        A/R Manager
        Health Care Practice Management
        1602 Newport Gap Pike
        Wilmington, DE 19808
        302-633-5840 Ext 321
        302-633-5844 (fax)




        [Non-text portions of this message have been removed]
      • Shannon Q
        I wanted to add that Medicare does require the modifier AT for payment, because they only cover active / corrective treatment and do not cover
        Message 3 of 8 , Jun 23, 2010
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          I wanted to add that Medicare does require the modifier AT for payment, because they only cover active / corrective treatment and do not cover maintainance. 
          Shannon




          ________________________________
          From: Shannon Q <intotherosegarden@...>
          To: MedicalBillers@yahoogroups.com
          Sent: Wed, June 23, 2010 11:47:39 AM
          Subject: Re: [MedicalBillers] AARP help


          I see. That's a completely different situation from what I imagined :)

          I would recommend looking at the LCD for your area. The LCD for MD, DE, PA, NJ and DC is here:

          https://www.highmarkmedicareservices.com/policy/mac-ab/l27480-r4.html

          The LCD will tell you which diagnosis codes are covered.

          If you want to share your locataion and what diagnosis you are using, I might be able to help you sort it out.
           Shannon Quinn
          A/R Manager
          Health Care Practice Management
          1602 Newport Gap Pike
          Wilmington, DE 19808
          302-633-5840 Ext 321
          302-633-5844 (fax)




          [Non-text portions of this message have been removed]
        • djgeisel
          In our state TX, you must use DX codes from the Medicare approved list. If you do not it will be denied. Check the LCD and Correct the claim. What is the DX
          Message 4 of 8 , Jun 24, 2010
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            In our state TX, you must use DX codes from the Medicare approved list. If you do not it will be denied. Check the LCD and Correct the claim. What is the DX you are using and what level of CMT are you using? I bill stricly for chiro / CMT and it goes through trailblazers so if you are the same I might know the DX code you should be using.
            Diana

            --- In MedicalBillers@yahoogroups.com, "healthygrl2008" <healthygrl2008@...> wrote:
            >
            > Hi everyone...I rarely get on here....but it is always interesting to look thru the emails and see what I can learn. Thanks for being a help to me without even knowing it!!!
            >
            > My prob with AARP!!! uugh! I sent claims, EOB claims NPI is wrong, call AARP- NPI is fine, "please resubmit" Ok- so I resubmit with a copy of the EOB and my notes of who/when I called. The same claim comes back denied but this time because its not a Medicare covered serivce. There is only 1 CPT for a spinal adjustment (at each level). I call and point that out- they 'reprocess it" while I'm on the phone. 3wks later- same claims comes back denied again for NPI# being wrong....and around we go! I haven't actually gotten paid on them in almost a year. I even had a claims speicialst assigned to one patients file- they ultimately had me resubmit the claims 6 different times and in they end they claim my diagnosis codes weren't medicare compliant!!!
            > Does that mean I should have used AT for active treatment instead of the numberical DX codes??
            >
            > Thanks for your help!!
            > Karen
            >
          • Karen Vulgamore
            thanks!! ________________________________ From: djgeisel To: MedicalBillers@yahoogroups.com Sent: Thu, June 24, 2010 11:42:42 AM
            Message 5 of 8 , Jun 29, 2010
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              thanks!!




              ________________________________
              From: djgeisel <djgeisel@...>
              To: MedicalBillers@yahoogroups.com
              Sent: Thu, June 24, 2010 11:42:42 AM
              Subject: [MedicalBillers] Re: AARP help

               
              In our state TX, you must use DX codes from the Medicare approved list. If you do not it will be denied. Check the LCD and Correct the claim. What is the DX you are using and what level of CMT are you using? I bill stricly for chiro / CMT and it goes through trailblazers so if you are the same I might know the DX code you should be using.
              Diana

              --- In MedicalBillers@yahoogroups.com, "healthygrl2008" <healthygrl2008@...> wrote:
              >
              > Hi everyone...I rarely get on here....but it is always interesting to look thru the emails and see what I can learn. Thanks for being a help to me without even knowing it!!!
              >
              > My prob with AARP!!! uugh! I sent claims, EOB claims NPI is wrong, call AARP- NPI is fine, "please resubmit" Ok- so I resubmit with a copy of the EOB and my notes of who/when I called. The same claim comes back denied but this time because its not a Medicare covered serivce. There is only 1 CPT for a spinal adjustment (at each level). I call and point that out- they 'reprocess it" while I'm on the phone. 3wks later- same claims comes back denied again for NPI# being wrong....and around we go! I haven't actually gotten paid on them in almost a year. I even had a claims speicialst assigned to one patients file- they ultimately had me resubmit the claims 6 different times and in they end they claim my diagnosis codes weren't medicare compliant!!!
              > Does that mean I should have used AT for active treatment instead of the numberical DX codes??
              >
              > Thanks for your help!!
              > Karen
              >







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