Medical Claim Form
If a CPT code is performed multiple times, we should be able to reflect that on the CMS 1500 form. We should be able to list one procedure (CPT 21248 or CDT 6010) on the medical claim form (line 24D), the number of times it was done (line 24G), and the charges should be a multiple of the two (line 24F). I've made several calls and have been told this is the way the system was developed and that it is a programming issue.If a medical carrier pays the 1st line at 100 percent for an operation, and each subsequent line is paid at 50, we would lose a tremendous amount of money by itemizing 6 implants. The first would be paid at 100% and the subsequent 5 would be paid at 50%. We should be reimbursed at 100% for all 6. Please reformat the way the system pulls codes into the CMS 1500 form so we can maximize our reimbursement. This formatting error makes OMS Vision practically useless for printing medical claim forms. Has anyone figured a way around this?
Thanks for the feedback.
Karen McCoy commented
Kind of off-topic but 21248 is not billed the same as D6010. It is for 1/2 of an arch regardless of # of implants.
Karen C, Biller commented
I have to type Medicare claims for submission as line items don't post correctly. For example Medicare wants multiple extractions billed on one line with 12 as the quantity and the total in the fee line.
Jeffrey Carter commented
You must learn the difference between programing and payment rules. The multiple procedure reduction is a payer standard. The payer systems are fixed to edit at 100%, 50% and 25%. This is different from dental. If a code is used multiple times it needs a modifier -- or else the processor assumes it is a double bill. If using implants -- would need a unique modifier like tooth number or quadant. -- but will still expect discount pricing!
I agree wholeheartedly. The way the system is set up now it makes it impossible to be paid the maximimum reimbursement.
I totally agree with you on this. I am so glad that we are not the only office that is having this problem. I could not imagine that we are the only ones in the country filing a medical claim correctly. The ONLY way I can do this is to print the claim form and make the corrections and mail the form. NOW the problem is that we are too large and have to send medicare claims electronically. I have now found out that OMS does not support electronic medical filing. (NOT that they would be sent correctly anyway) Norma has said that the correction to this problem will be resolved in the 14.0 version. UNFORTUNATELY we are only in the 12.0 and that is a little too far off for us. We are SERIOUSLY looking at other options. There are just way too many problems with this software. Please contact me if you can