RE: BCBS bundling

[Guest guest]

This is from our billing manager.

Ted

After the nightmare in Medisoft, I never

bill more then one DOS on a HCFA, but in the past if they were denied I would

call and explain they are two separate dos. It is ok to bill more then

one DOS on a HCFA (no coding law states you cant, it just confuses insurance

computer systems). Yes it can be automatically bundled but that is their

system error and they should reprocess. As for the flat out denial

stating it is a PT code and not “in scope”, that has never happened

before but I can see them trying: “Who can legally perform a

massage? It is determined by local or state law. Practitioners will

usually find that defined within the “scope of practice” for their

license. However, insurance and third party payers will reimburse

according to their contracts and policies.” So if this is an out of

state blue cross and it is in that states contract that Chiro can not do

massage then I would say it’s not a write off it’s a non-covered

benefit and therefore patients responsibility. But make them reprocess

claim with an EOB that states that. If it is a local blue cross, I

don’t get it at all.

Lanie

Ted Forcum,

DC, DACBSP

ACA Sports Council, 2nd Vice President

Back

In Motion Sports Injuries Clinic, LLC

11385 SW Scholls Ferry Road

Beaverton, Oregon 97008

503.524.9040

www.bimsportsinjuries.com

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From:

[mailto: ] On Behalf Of Sorah

Sent: Tuesday, June 10, 2008 12:52

PM

'Oregon DC's'

Subject: BCBS

bundling

Docs,

My office

manager just ran into a unique code bundling situation. BCBS bundled

three units of 97124 and 98940 that were performed on two different days.

The two procedures were performed close enough chronologically that they showed

up on the same claim form. The BCBS representative said it did not matter

that they were done on different days, but because they showed up on the same

HCFA they were automatically bundled. Then, my office manager got a call

back and the representative said that BCBS would not pay for the 97124 code at

all because it does not fall under a chiropractor’s scope of

license. It is considered physiotherapy and is only covered under a

physical therapist. Has this been happening to anyone else?

Sorah, DC

Corvallis, OR

msorahnwhealing