One of our providers files her professional claims, she entered an agreement with Aetna and thought she would be paid $6000 for providing global maternity care. Imagine her surprise when the fine print she agreed to was for "Aetna's Market Fee." After ten months of care, she made $1600. :-(
“Insurers generally are attempting to convince the customer when selling the policy that everything is covered and convince the court when a claim is made that nothing is covered.”
— South Carolina Supreme Court
Newborn Nursery Charged Even When Baby Stays with Mother
THE PROBLEM: Kunal Kampani was upset when he got a bill with a hospital nursery charge. His newborn baby had stayed in the room with his wife. "There was $1,650 in nursery room charges for two days. It was surprising because we never used it at all during the hospital stay," he said. "They are now threatening a collection agency. Can you please advise what should I do?"
"Children are expensive - and it starts from the moment they show up. Whether they sleep in the room or in the nursery, hospital charges are exactly the same" says Texas Health Presbyterian of Plano.
"Each infant is assigned a nursery nurse, who provides the same care, the same supplies, and the same amount of time and attention whether the infant is in mom's room or the nursery," hospital spokeswoman Rachel Horton Raya said by e-mail. "Daily charges are the same in either situation and include nursing care and supplies such as diapers, wipes, linens, etc."
Read full article here: Hospital Charges Apply Even When the Newborn Don't Use It
Insurance companies owe a duty of good faith and fair dealing to the people who they insure. This duty is often referred to as the "implied covenant of good faith and fair dealing," and it automatically exists by operation of law in every insurance contract. As a general rule, if an insurance provider violates the covenant of good faith and fair dealing, a policyholder may sue in tort in addition to bringing a standard breach of contract claim. Suing in tort is advantageous to a plaintiff because it allows him or her to collect punitive damages in addition to general and special damages for the provider's breach. For this reason, attorneys prefer to include a cause of action in tort for bad faith insurance practices whenever possible.
Most insurance companies process our claims lawfully; however, in the event they don't, we are prepared to move forward legally.
For services provided using telemedicine (real-time, interactive, audio and visual) between Jan. 27, 2020 (the day the public health emergency was declared) and June 30, 2020, CMS says to add modifier 95, synchronous telemedicine services rendered via real-time interactive audio and visual video telecommunication system, on the claim.
For services going forward via telehealth, until June 3, 2020, use modifier 95.
For telehealth services performed starting July 1, 2020 until the end of the public health emergency use HCPCS code G2025 to identify services that were furnished via Tele health in an RHC or an FQHC these claims will be paid at the $92 rate.
MACs will automatically reprocess claims with G0071 for claims processed after March 1. The new rate is a blended rate, based on the payment rates of 99421—99423, and the two HCPCS codes for virtual communication, G2012 and G2010.
Credit: Coding Intel @ www.codingintel.com
15. Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)
s) COVID-19 infection in pregnancy, childbirth, and the puerperium
During pregnancy, childbirth or the puerperium, a patient admitted (or presenting for a health care encounter) because of COVID-19 should receive a principal diagnosis code of O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, followed by code U07.1, COVID-19, and the appropriate codes for associated manifestation(s). Codes from Chapter 15 always take sequencing priority.
Exposure to COVID-19
For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, assign code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.
For cases where there is an actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown, assign code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.
Midwives are reporting that they receive calls from potential clients that have HMO policies. Clients can call their insurance and ask for a single case agreement to use an out-of-network facility due to the COVID-19 pandemic. Insurance companies are granting these requests. This is good news for midwives! Potential clients can email us a firstname.lastname@example.org if they have questions.
It takes a while for the claim forms to load, if you hit "submit" three times we receive the claim three times. Please only click the "submit" button once. Thanks!
I hope you are enjoying our new website. Thank you for your patience as we tweak the forms. A couple of housekeeping points to help things run more efficiently. When filling out forms: