Re: Coding & more
From: art fougner, md (evsono@pipeline.com)
Tue Jan 4 12:34:58 2000
Amen! they all use the claims manual from John Grisham's Great Benefit
Insurance Co., Section U to be precise. "Deny All Claims" Electronic
Submission = electronic rejection!
Art
At Tue, 04 Jan 2000, Rafael Haciski MD wrote:
>
>Obviously you have not come across payors (as in Blue Cross/Blue Shield) who
>disregard modifiers, where modifiers kick the claim out, and whose computers
>are programmed to ignore or downright reject such modified claims. Rather
>that getting the 30% more, you do not even get the paltry usual amount.
>
>--
>Rafael Haciski, MD FACOG
>Gynecology & Infertility Assoc.
>Baltimore MD
>(410) 825-0020
>WEB PAGE ---- http://www.ivf-md.com
>E-mail -------Haciski@ivf-md.com
>
>----------
>>From: Joanne Bulley <jbulley@cheshire.net>
>>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@talk.obgyn.net>
>>Subject: Coding & more
>>Date: Thu, Dec 30, 1999, 17:37
>>
>> Wow!!
>>
>> I have had a crazy December and finally caught up with the List! Great stuff
>> going on!
>>
>> Coding - when using the modifier -22 INCLUDE the op note AND increase your
>> asking fee by 30-100% - pending how much harder the case was as documented.
>> If you put -22 and don't up the fee, you will get the same payment. This is
>> what I was told to do at the McVey coding seminar and it worked. Don't wait
>> till they ask for the records - put them with the original bill, with your
>> office manager finding out who at the ins co needs to review it so it is sent
>> straight to that person's attention.
>>
>> As far as the prolonged services - the information is in the CPT code book.
>> To quote someone else - don't be a dork - READ IT.
>>
>> Great discussion of the VBAC issue. I am now a private Gyn (one year), was in
>> a group practice of 3-5 OB-GYNs for the prior 13 years. This county in NH is
>> reimbursed at nearly the lowest of NH counties and NH is one of the lowesdt
>> reimbursed in the states (for Medicaid and medicare at any rate) - so the
>> issue of # of patients needed to care for vs basic overhead is VERY real.
>> Every patient rescheduled due to Doc in L&D takes up a space in which a
>> different patient could have been seen - so to close up shop for every VBAC or
>> whatever patient doesn't work.. Having left the practice I do not know how
>> they are dealing with this issue. When I left (Sept 98) they were pushing
>> HARD to have everyone VBAC.
>>
--
Art Fougner, MD
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