I just started reading it and I can see some problems. It makes reference to terms such as "prevailing rate" and balance billing. BUT, it does NOT define these terms.

I see this here in Florida. The problem is that these terms are usually left up to the insurance company to define.

If this law allows balance billing, which it seems it does, only with non-contracted... ]]> feeds@yuku.com (Steve Verno) http://medicalassociationofbillers.yuku.com/topic/8041 Sun, 08 Nov 2009 03:57:09 GMT http://medicalassociationofbillers.yuku.com/topic/8040/t/Medicare-ERA-opt-out.html
We did this recently with Blue Cross of CA as well. They didn't offer this when they ended paper EOB's but you can opt-out FYI
]]> feeds@yuku.com (dccped) http://medicalassociationofbillers.yuku.com/topic/8040 Sat, 07 Nov 2009 19:28:14 GMT http://medicalassociationofbillers.yuku.com/topic/8039/t/Prior-Authorizations-and-ABNs-for-Other-Insurances.html Hello Group!

I have a few questions I am needing some feedback on. I'm hoping you can help me.

How is everyone handling prior authorizations for insurances that require them on CTs, MRI, MRA, etc.? Do you have a "cheat sheet" or form that you use? Is somone looking up the CPTs codes & writing them on a cheat list (the hospital orders don't have CPTs on the forms) Who does the prior authorizations in your office? The nurse, billing, front desk?

The Secretary of Health and Human Services has invoked her waiver authority under Section 1135 of the Social Security Act. This allows for the waiver or modification of... ]]> feeds@yuku.com (Steve Verno) http://medicalassociationofbillers.yuku.com/topic/8038 Thu, 05 Nov 2009 13:00:49 GMT http://medicalassociationofbillers.yuku.com/topic/8037/t/2ndary-coins.html This seems like such a simple questions.....Medicare is primary and pays a claim leaving a patient responsibility of 38.00. The claim is automatically crossed over to Blue Cross and Blue Cross pays 5.00 and states there is no further responsibility due. Account has balance of 33.00 and patient is refusing to pay the balance because Blue Cross states they have no responsibility. Doctor is contracted with Blue Cross. Is the balance a write off?

feeds@yuku.com (Steve Verno) http://medicalassociationofbillers.yuku.com/topic/8032 Wed, 04 Nov 2009 09:50:31 GMT http://medicalassociationofbillers.yuku.com/topic/8031/t/Auditing-Fees.html
I was wondering if anyone can help me out.....I would like to get into auditing, however I have no idea what to charge a client for this.....Does anyone have any knowledege or websites of where I can find this information??

Thanks

Cheryl ]]> feeds@yuku.com (pacoder) http://medicalassociationofbillers.yuku.com/topic/8031 Wed, 04 Nov 2009 07:25:51 GMT http://medicalassociationofbillers.yuku.com/topic/8030/t/Paraplegic-with-foot-ulcers.html
99203-25 and 344.1, 707.14?? Does the dx order matter?

The E/M code was denied. We did not use modifier 25. Should we?

Connie


]]> feeds@yuku.com (chillard) http://medicalassociationofbillers.yuku.com/topic/8030 Wed, 04 Nov 2009 04:44:44 GMT http://medicalassociationofbillers.yuku.com/topic/8029/t/Training-Primer-Deductibles.html
THis is a very important item with almost every insurance policy.

A deductible is an amount that a person is contractually required to pay before an insurance company issues a check for medical benefit payments. A dedutible is an added out of pocket expense that is separate from copays and coinsurance. For example, if a person has a $500 deductible, a visit on January 4 costs $100. If the insurance company allows $100 for the visit, instead of paying the... ]]> feeds@yuku.com (Steve Verno) http://medicalassociationofbillers.yuku.com/topic/8029 Wed, 04 Nov 2009 03:06:32 GMT http://medicalassociationofbillers.yuku.com/topic/8028/t/More-New-Info-from-CMS.html From: Haugen, Valerie A. (CMS/CMM)