96110 Modifier Requirements Change Again

Posted on 11. Oct, 2010 by jennifer.godreau.

BC/BS UHC, tell coder to halt 96110-59 denials with 96110-79.

If you’re ready to bill 96110 and 96110-59, think again.

One office was billing 96110 (Developmental testing; limited [e.g., Developmental Screening Test II, Early Language Milestone Screen], with interpretation and report) with modifier 59 (Distinct procedural service). BlueCross/BlueShield (BC/BS), UnitedHealthcare (UHC), and other insurers were denying the 96110-59s. “I called BC/BS on 8-19-2010 and was told that we should be using a

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Payer Update: UHC Sticks With Consult Codes

Posted on 12. Jan, 2010 by .

Check with Medicaid plans, insurer warns.

You can breathe a sigh of relief — one major payer will stick with 99241-99255.

UnitedHealthcare (UHC) commercial plans will make no change in payment for consultation codes (99241-99255) at this time, according to a UHC e-mail alert. “Physicians may continue to submit claims for these services, and will be reimbursed according to United-Healthcare payment policies”.

Beware: One Medicaid plan will eliminate consult pay and force you to follow Medicare’s rule of using office and hospital codes in lieu of 99241-99255. “For AmeriChoice Medicaid plans that follow Medicare rules for their fee schedules, AmeriChoice will be aligning with CMS rules and implement the change effective January 1, 2010,” the email notice states. “For all other Medicaid states, AmeriChoice will follow the  UnitedHealthcare commercial position and continue to pay for the consult codes, until directed otherwise by a state to pursue other strategies.”

Watch your mail for a UHC payer news notice and an article in the January Network Bulletin.

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FREE WEBINAR THIS MONTH: 2010 Consult Coding Update, with Jennifer Godreau.

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Pssssssst. Payer Report Cards Are Out

Posted on 05. Aug, 2009 by .

If you know your payers’ strengths and weaknesses, you’re better equipped to fight denials and negotiate contracts that are in your best interest.

So check out the American Medical Association’s second annual National Health Insurer Report Card. The AMA has gathered data and rated large payers on criteria like payment timeliness, accuracy, claim edit sources and denials, according to an American Medical News article that summarizes trends in the report card.

Drawback: The AMA’s payer report card looks only at big, national insurers (Aetna, Anthem, Blue Cross and Blue Shield, Cigna, Coventry, Health Net, Humana, UnitedHealthcare and Medicare). To get the dirt on smaller or regional payers, check out this resource from Athenahealth.

To see the AMA’s payer report card, go here.

Are your payers ‘remedial’ at best? USE THE APPEALS PROCESS LIKE A PRO, with APPEALS QUEEN Barbara Cobuzzi.

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UnitedHealthcare Throws Practices a Bone

Posted on 16. Mar, 2009 by .

No foolin’. After April 1, UnitedHealthcare will no longer reduce reimbursement rates without warning, and 70,000 physicians stand to benefit from the new policy, reports American Medical News.

Until now, UHC used a ‘progressive RVU methodology’ to set reimbursement rates for procedures. Translation: Reimbursement could drop without warning.

Now, UHC will base its reimbursement rates on the 2008 RBRVS … More …

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