Question: A doctor recently told me that appending modifier GY to the refraction code would guarantee payment by a secondary insurer when Medicare denies it. Is this true? Answer: Modifier GY (Item or service statutorily excluded or does not meet the ...
Despite disadvantages, a new tax ID is a must when physicians leave your group.
Question: One of our optometrists wants to stop billing under the group’s tax ID and start billing under his own tax ID. I’m concerned that doing so will confuse the insurance companies and slow down his income, even though he has personally called some to notify them of the change and the effective date. Some payers are now asking for new W9 forms. Is there an easy way to do it?
Answer: Your optometrist can change his tax ID at any time, but you must submit a new W9 to your payers, in addition to a letter explaining that he will no longer be practicing under the group’s tax ID.
Downside: Yes, the optometrist’s income will be slowed. You also run the risk that the payer’s enrollment department does not handle the paperwork properly. Other billers have reported instances of the income being paid to the old tax ID or not being paid at all. Claims can also be lost even though the correct paperwork has been submitted multiple times.
If your optometrist is currently part of a group, and he is leaving the group, he needs his own tax ID. Many legal issues will arise from this. For example, if he is staying in the same office suite, he will have to pay market rent for the offices and staff that he is using. When patients move between the old practice and his new practice, questions will arise about which patients are considered new and which are considered established patients.
Much of this will have to be determined by the legal structure that is set up as he leaves the group. This can be a much more complex change than it appears on the...
Don’t miss CPT 2010 ‘either/or’ instruction for hemorrhoid location.
You can’t choose a hemorrhoidectomy code if you don’t know the distinction between internal and external hemorrhoids. Let our experts guide you through the anatomy and coding maze to help you...
Find out what incident-to requirements you have to meet.
Question: Is there any circumstance in which a group can bill all services and all providers (including other physicians) under just the head doctor? I know we can bill NPP...
Sample ICD-9 codes to support medical necessity for trigger point injections. Counting the right items, knowing insurer-allowed diagnoses, and documenting affected muscles will get your trigger point injection (TPI) claims paid while protecting you from paybacks. Further, knowing each insurers’ covered diagnoses for TPIs is vital to healthy coding. √ Do Count Muscles Injected Coders should report 20552 (Injection[s]; single [...] Related articles:
Code 488.1 does not = confirmed lab. Swine flu has made an early arrival in several states and in your 2009 preventive and sick coding. To avoid denials for H1N1 vaccination administration, you’re going to have to check which of three administration code options your major payers want. “Some payers want you to use the new [...] Related articles: