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Re: 99050 After Hours - Coding Help!

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  • Melinda
    Thanks Fami!
    Message 1 of 8 , May 31, 2011
    • 0 Attachment
      Thanks Fami!

      --- In MedicalBillers@yahoogroups.com, fami tab <marmar623@...> wrote:
      >
      > Hi,
      > I do not think this is considered holiday - as you usually open during the
      > business hours Friday till 5:00 - you plan to close early due to long weekend /
      > holidays.
      >
      >
      > As Josette said, was this a cash visit / billing insurance? If billing
      > insurance for after hours you must proof that office was closed. You need you
      > office policy.
      > Fami
      >
      >
      >
      > ________________________________
      > From: josette sylvan <abcmdbiller123_55@...>
      > To: MedicalBillers <medicalbillers@yahoogroups.com>
      > Sent: Fri, May 27, 2011 6:22:47 PM
      > Subject: RE: [MedicalBillers] 99050 After Hours - Coding Help!
      >
      >
      > Most importantly, you failed to mention if there is any insurance coverage? if
      > its not cash............
      >
      > do you par with the insurance
      > what is the drs specialty
      > is the patient eligible
      > would the service need authorization????????
      >
      > the coding is good as far as i can see, office usually makes up their own fee
      > schedule for services, it is usually derived from what it cost you to provide
      > the service plus 10% for profit.
      >
      >
      > Not the case if it is an insurance plan situation, again if the dr par or dont
      > par is the question? you may not get paid at all! good luck
      >
      >
      >
      > To: MedicalBillers@yahoogroups.com
      > From: melindadocsmith@...
      > Date: Fri, 27 May 2011 21:50:29 +0000
      > Subject: [MedicalBillers] 99050 After Hours - Coding Help!
      >
      >
      >
      >
      >
      >
      > One of our patients called, after the office was closed for the Memorial Day
      > weekend, and requested to bring a young 1 yr old boy in to be looked at for
      > possible stitches. Our patient runs a day care and it was one of her day care
      > children - not her own. This mom is notorious for paging him after hours, when
      > he is not on-call. Dr. said he'd see the boy. They arrived approx. 12:45pm.
      >
      > Apparently, after the patient was here, we discovered that the child's regular
      > family practice would not suture a 1 yr old & neither would the urgent care
      > clinic. We are billing 12011 as the cheek needed suturing.
      >
      > Would you also bill the 99050? What would be your fee amt?
      > 99050 = Services provided in the office at times other than the regularly
      > scheduled office hours, or days when the office is normally closed (e.g.
      > holiday, saturday, or sunday), in addition to the basic service. Our office is
      > normally open Mon, Tues, Thurs & Fri 8-5 and Wed 8-12. We close for lunch from
      > 12:1:30pm daily.
      >
      > Would you add a modifier 25 on the 99050?
      >
      > Your help is appreciated!
      >
      > Melinda Brown, CMBS
      > Ins Biller
      >
      >
      >
      >
      >
      > [Non-text portions of this message have been removed]
      >
      >
      >
      > ------------------------------------
      >
      > Yahoo! Groups Links
      >
      >
      >
      > [Non-text portions of this message have been removed]
      >
    • josette sylvan
      NOW WE GOT SOMETHING TO WORK WITH YOU PAR SO CHARGE WHAT EVER YOU WANT TO CHARGE BECAUSE PAR DRS ONLY RECIEVE THE ALLOWABLE AMOUNTS FROM THE INSURANCE COMPANY.
      Message 2 of 8 , Jun 1, 2011
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        NOW WE GOT SOMETHING TO WORK WITH

        YOU PAR SO CHARGE WHAT EVER YOU WANT TO CHARGE BECAUSE PAR DRS ONLY RECIEVE THE ALLOWABLE AMOUNTS FROM THE INSURANCE COMPANY. JUST TRY NOT TO UNDER CHARGE. GOOD LUCK



        To: MedicalBillers@yahoogroups.com
        From: melindadocsmith@...
        Date: Tue, 31 May 2011 16:36:04 +0000
        Subject: [MedicalBillers] Re: 99050 After Hours - Coding Help!






        Premera Blue Cross & Dr. is Par.
        Family Practice
        Patient is eligible for coverage
        Prior auth not needed outpatient services. No PCP is necessarily assigned.

        Thanks for your reply!

        --- In MedicalBillers@yahoogroups.com, josette sylvan <abcmdbiller123_55@...> wrote:
        >
        >
        > Most importantly, you failed to mention if there is any insurance coverage? if its not cash............
        >
        > do you par with the insurance
        > what is the drs specialty
        > is the patient eligible
        > would the service need authorization????????
        >
        > the coding is good as far as i can see, office usually makes up their own fee schedule for services, it is usually derived from what it cost you to provide the service plus 10% for profit.
        >
        > Not the case if it is an insurance plan situation, again if the dr par or dont par is the question? you may not get paid at all! good luck
        >
        >
        > To: MedicalBillers@yahoogroups.com
        > From: melindadocsmith@...
        > Date: Fri, 27 May 2011 21:50:29 +0000
        > Subject: [MedicalBillers] 99050 After Hours - Coding Help!
        >
        >
        >
        >
        >
        >
        > One of our patients called, after the office was closed for the Memorial Day weekend, and requested to bring a young 1 yr old boy in to be looked at for possible stitches. Our patient runs a day care and it was one of her day care children - not her own. This mom is notorious for paging him after hours, when he is not on-call. Dr. said he'd see the boy. They arrived approx. 12:45pm.
        >
        > Apparently, after the patient was here, we discovered that the child's regular family practice would not suture a 1 yr old & neither would the urgent care clinic. We are billing 12011 as the cheek needed suturing.
        >
        > Would you also bill the 99050? What would be your fee amt?
        > 99050 = Services provided in the office at times other than the regularly scheduled office hours, or days when the office is normally closed (e.g. holiday, saturday, or sunday), in addition to the basic service. Our office is normally open Mon, Tues, Thurs & Fri 8-5 and Wed 8-12. We close for lunch from 12:1:30pm daily.
        >
        > Would you add a modifier 25 on the 99050?
        >
        > Your help is appreciated!
        >
        > Melinda Brown, CMBS
        > Ins Biller
        >
        >
        >
        >
        >
        > [Non-text portions of this message have been removed]
        >





        [Non-text portions of this message have been removed]
      • Melinda
        Josette, I ended up billing the 99050 with the 12011 and set the 99050 fee at 40% of the procedure performed. We ll see what happens. Thanks for your input.
        Message 3 of 8 , Jun 2, 2011
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          Josette,

          I ended up billing the 99050 with the 12011 and set the 99050 fee at 40% of the procedure performed. We'll see what happens.

          Thanks for your input.

          Melinda Brown, CMBS
          Ins Biller

          --- In MedicalBillers@yahoogroups.com, josette sylvan <abcmdbiller123_55@...> wrote:
          >
          >
          > NOW WE GOT SOMETHING TO WORK WITH
          >
          > YOU PAR SO CHARGE WHAT EVER YOU WANT TO CHARGE BECAUSE PAR DRS ONLY RECIEVE THE ALLOWABLE AMOUNTS FROM THE INSURANCE COMPANY. JUST TRY NOT TO UNDER CHARGE. GOOD LUCK
          >
          >
          >
          > To: MedicalBillers@yahoogroups.com
          > From: melindadocsmith@...
          > Date: Tue, 31 May 2011 16:36:04 +0000
          > Subject: [MedicalBillers] Re: 99050 After Hours - Coding Help!
          >
          >
          >
          >
          >
          >
          > Premera Blue Cross & Dr. is Par.
          > Family Practice
          > Patient is eligible for coverage
          > Prior auth not needed outpatient services. No PCP is necessarily assigned.
          >
          > Thanks for your reply!
          >
          > --- In MedicalBillers@yahoogroups.com, josette sylvan <abcmdbiller123_55@> wrote:
          > >
          > >
          > > Most importantly, you failed to mention if there is any insurance coverage? if its not cash............
          > >
          > > do you par with the insurance
          > > what is the drs specialty
          > > is the patient eligible
          > > would the service need authorization????????
          > >
          > > the coding is good as far as i can see, office usually makes up their own fee schedule for services, it is usually derived from what it cost you to provide the service plus 10% for profit.
          > >
          > > Not the case if it is an insurance plan situation, again if the dr par or dont par is the question? you may not get paid at all! good luck
          > >
          > >
          > > To: MedicalBillers@yahoogroups.com
          > > From: melindadocsmith@
          > > Date: Fri, 27 May 2011 21:50:29 +0000
          > > Subject: [MedicalBillers] 99050 After Hours - Coding Help!
          > >
          > >
          > >
          > >
          > >
          > >
          > > One of our patients called, after the office was closed for the Memorial Day weekend, and requested to bring a young 1 yr old boy in to be looked at for possible stitches. Our patient runs a day care and it was one of her day care children - not her own. This mom is notorious for paging him after hours, when he is not on-call. Dr. said he'd see the boy. They arrived approx. 12:45pm.
          > >
          > > Apparently, after the patient was here, we discovered that the child's regular family practice would not suture a 1 yr old & neither would the urgent care clinic. We are billing 12011 as the cheek needed suturing.
          > >
          > > Would you also bill the 99050? What would be your fee amt?
          > > 99050 = Services provided in the office at times other than the regularly scheduled office hours, or days when the office is normally closed (e.g. holiday, saturday, or sunday), in addition to the basic service. Our office is normally open Mon, Tues, Thurs & Fri 8-5 and Wed 8-12. We close for lunch from 12:1:30pm daily.
          > >
          > > Would you add a modifier 25 on the 99050?
          > >
          > > Your help is appreciated!
          > >
          > > Melinda Brown, CMBS
          > > Ins Biller
          > >
          > >
          > >
          > >
          > >
          > > [Non-text portions of this message have been removed]
          > >
          >
          >
          >
          >
          >
          > [Non-text portions of this message have been removed]
          >
        • josette sylvan
          Thats great, good luck! mel, we are here for you :) To: MedicalBillers@yahoogroups.com From: melindadocsmith@yahoo.com Date: Thu, 2 Jun 2011 17:08:53 +0000
          Message 4 of 8 , Jun 2, 2011
          • 0 Attachment
            Thats great, good luck! mel, we are here for you :)



            To: MedicalBillers@yahoogroups.com
            From: melindadocsmith@...
            Date: Thu, 2 Jun 2011 17:08:53 +0000
            Subject: [MedicalBillers] Re: 99050 After Hours - Coding Help!






            Josette,

            I ended up billing the 99050 with the 12011 and set the 99050 fee at 40% of the procedure performed. We'll see what happens.

            Thanks for your input.

            Melinda Brown, CMBS
            Ins Biller

            --- In MedicalBillers@yahoogroups.com, josette sylvan <abcmdbiller123_55@...> wrote:
            >
            >
            > NOW WE GOT SOMETHING TO WORK WITH
            >
            > YOU PAR SO CHARGE WHAT EVER YOU WANT TO CHARGE BECAUSE PAR DRS ONLY RECIEVE THE ALLOWABLE AMOUNTS FROM THE INSURANCE COMPANY. JUST TRY NOT TO UNDER CHARGE. GOOD LUCK
            >
            >
            >
            > To: MedicalBillers@yahoogroups.com
            > From: melindadocsmith@...
            > Date: Tue, 31 May 2011 16:36:04 +0000
            > Subject: [MedicalBillers] Re: 99050 After Hours - Coding Help!
            >
            >
            >
            >
            >
            >
            > Premera Blue Cross & Dr. is Par.
            > Family Practice
            > Patient is eligible for coverage
            > Prior auth not needed outpatient services. No PCP is necessarily assigned.
            >
            > Thanks for your reply!
            >
            > --- In MedicalBillers@yahoogroups.com, josette sylvan <abcmdbiller123_55@> wrote:
            > >
            > >
            > > Most importantly, you failed to mention if there is any insurance coverage? if its not cash............
            > >
            > > do you par with the insurance
            > > what is the drs specialty
            > > is the patient eligible
            > > would the service need authorization????????
            > >
            > > the coding is good as far as i can see, office usually makes up their own fee schedule for services, it is usually derived from what it cost you to provide the service plus 10% for profit.
            > >
            > > Not the case if it is an insurance plan situation, again if the dr par or dont par is the question? you may not get paid at all! good luck
            > >
            > >
            > > To: MedicalBillers@yahoogroups.com
            > > From: melindadocsmith@
            > > Date: Fri, 27 May 2011 21:50:29 +0000
            > > Subject: [MedicalBillers] 99050 After Hours - Coding Help!
            > >
            > >
            > >
            > >
            > >
            > >
            > > One of our patients called, after the office was closed for the Memorial Day weekend, and requested to bring a young 1 yr old boy in to be looked at for possible stitches. Our patient runs a day care and it was one of her day care children - not her own. This mom is notorious for paging him after hours, when he is not on-call. Dr. said he'd see the boy. They arrived approx. 12:45pm.
            > >
            > > Apparently, after the patient was here, we discovered that the child's regular family practice would not suture a 1 yr old & neither would the urgent care clinic. We are billing 12011 as the cheek needed suturing.
            > >
            > > Would you also bill the 99050? What would be your fee amt?
            > > 99050 = Services provided in the office at times other than the regularly scheduled office hours, or days when the office is normally closed (e.g. holiday, saturday, or sunday), in addition to the basic service. Our office is normally open Mon, Tues, Thurs & Fri 8-5 and Wed 8-12. We close for lunch from 12:1:30pm daily.
            > >
            > > Would you add a modifier 25 on the 99050?
            > >
            > > Your help is 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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