Posting EOB before the check and billing patient for pre - existing and CO 97

FAQ

Can we post the EOB payment before the check is issued?

Ans : No. We couldn’t.

Note : Before posting the EOB payments we have to double check if the check was cashed or not. Call the insurance and get the encashment details and post the EOB.



Can we balance bill for Medicare denial CO 97

Ans : No. We couldn’t bill the patient.

Note : CO 97 Payment adjusted because this procedure/ service is not paid separately. It means that payment not paid seperately. Submit with correct modifier or take adjustment.


Can we bill the patient for a denied pre-existing condition claim

Ans : Yes. But make sure that the patient has secondary coverage; we need to send the entire bill to secondary along with the primary denial. Some carriers may be pay and some may not at that time you can bill the patient.

Note : Pre-existing condition refers to the terms and conditions entered in to between the carrier and the patients/subscribers before the beginning of the contract.  The rejection will usually say that the claim is being denied due to the pre-existing condition.  It would not specify what exactly; the condition is.  So carrier needs to be called to find out the pre-existing condition. Preexisting condition may be for anything.

Can anesthesia code a 53 modifier

Ans : Yes.

Note : You will report modifier 53 when a procedure concludes owing to a threat to the patient's well-being or other extenuating circumstances. For instance, the surgeon carries out a preop assessment, however during the evaluation he detects a carotid bruit (785.9, Other symptoms involving cardiovascular system); therefore he delays the surgery indefinitely until a better evaluation can be made. You can go for modifier 53 after anesthesia administration and/or a surgical preparation took place, and the procedure was actually started. You should think about the procedure discontinued when anesthesia ends early.

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