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Re: [MedicalBillers] AARP help

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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 1 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 2 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 3 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 4 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
            >







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