Ever contemplate why sometimes once you get reimbursed for a claim, the security business has "changed the written language to a much decorous standard for payment"? You submitted the claim as a 99214 but they paying you for a 99213 or even worse, a 99212. This trial is titled downcoding.

Do you have to accept it? Well in several cases you do. A lot will be on the agreement that you have next to the protection delivery service. Some contracts will single permit providers to mouth correct cpt codes. In that case, they can relocate a billed symbols to one of the allowed codes. Or the treaty may undertake that you can solely measure a clear in your mind number, or percent of claims at the superior codes.

But sometimes an security mover will only just downcode your charge and it is not due to bond specifications. In that grip you can allure it. We just now had a allege that the protection shipper downcoded a 99214 to a 99213 and told us that they simply allow a supplier to legal document a 99214 all 6 weeks for a tolerant. That is outlandish. How can that line utilize to any patient?

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Sometimes we only just have to cue the security carriers that the doctors are the ones who find the patient's wants. In this lawsuit we sent in bureau log and a missive advising them that we were attractive the processing of the contend. The medico had met the requirements to claim the request of a 99214 and their "guidelines" were inappropriate. We normative grant for the quality more or less 10 life future.

So if you are having problems next to your claims existence downcoded, and they are not due to compact specifications, you should appeal. Do not freshly accept what the life insurance carrier does. That is what they are reckoning on. Just regard as of how some currency they reclaim on the providers that do not do anything in the region of it.

Copyright 2008 - Michele Redmond

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