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Our clients are asking about a new phenomenon — insurance companies who send an explanation of benefits (EOB) with “virtual” payment. The EOB will state, “payment for this remittance is being made via virtual credit card; please process this payment as you would any credit card.”
This brings up several areas of concern. First, what if you don’t take credit cards? Some practices have not progressed this far, and they do not have the ability to accept these virtual payments.Read More
During a recent audit for one of my clients, I was working through some random CMS denials and noticed that several special stains had been denied. There were eight units billed and ALL had been denied by CMS and adjusted by the biller. Yet I know that the CMS National Coverage Determination (NCD) allows billing for one unit – why was that unit not approved?
I spoke with the billing agency and was informed that CMS will typically deny ALL charges — even if one should be approved — until the appeal is made. If the documentation supports the additional units, then CMS will make payment on all the unit(s).Read More
Since January 2014, there are more and more issues coming out of the woodwork with FSH billing and reimbursement. Earlier this year, we saw United Health Care (UHC) create their own application of an MUE to any CPT Code 88368 billed more than once per patient per day. While UHC is now in the process of recanting this, we are continuing to see Blue Cross Blue Shield of South Carolina (BCBS SC) deny 88368 as investigational.Read More