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November 2019 Client Newsletter

Medicaid HMO's - Now Downcoding
We are occasionally hearing other providers having the E&M codes downcoded when they bill with 1 Diagnosis code. This happens most commonly with Aetna and some Medicaid HMOs. We have not yet seen it with our clients, but it's best to begin some "preventive billing medicine."
As we have said for MANY years, be sure to include all relevant diagnoses on the charge form. This is especially important when you bill a 4th or 5th level code. Be sure the diagnoses/signs/symptoms are properly documented as well.
Use the diagnoses to "paint the picture" of the patient's health so the insurer understands why a higher level CPT code was used.
Just a reminder that effective January 1, 2020 Medicare will cease paying claims without the patient's new Medicare number. Be sure to REQUIRE patients to provide it, and when a patient calls for an appointment, verify that they have the new number, and remind them that the new number is required in order to be seen.
For our clients who check eligibility on the Medicare website, or who use the Healthpac Eligibility verification feature, Medicare requires the new number to do this also.


If a patient says they did not receive their card, they need to contact Medicare to obtain it. There have been MANY reminders sent by CMS to all Medicare patients.
2019 Client Newsletter Archive