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December 2021 Billing Newsletter |MD Medical Group

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PARTICIPATION REMINDERS

W E C U R R E N T L Y D O N O T P A R T I C I P A T E W I T H :

A E T N A M E M O R I A L H E R M A N

C I G N A F O C U S

P A L M E T T O ( R A I L R O A D M E D I C A R E )

W E A R E N O T I N C O N T R A C T W I T H O U T O F S T A T E M E D I C A R E P L A N S

We are only PAR with the Medicaid product for Cigna Healthsprings.

So please make sure you verify benefits! We will notify you when our providers are PAR with the

Medicare product.

Before using BCBS HMO plan we need to check the member benefits with the individual providers

NPI that Will be seeing the member, since we must be their PCP.

None of our DFW locations should see patients who have TCHP, only Houston Providers are PAR

with this plan.

CREDENTIALING

U t i l i z e t h e M C O g r i d t o k n o w w h i c h p a y e r w e a r e P A R w i t h .

I f y o u d o n o t s e e a p a y e r l i s t e d p l e a s e c a l l a n d v e r i f y b e n e f i t s f o r t h e

s e r v i c i n g p r o v i d e r t o d e t e r m i n e i f t h e p a t i e n t h a s i n / o u t o f n e t w o r k b e n e f i t s .

I M P O R T A N T I N F O R M A T I O N

Patients with

balance

Please allow to pay at the

clinic. We should never

turn patients that want to

make a payment away.

Questions about balance – Billing dpto. 972-957-3000 option 2.

Payment by phone – Patient Payment Collectors: Nuvia Lucio

ext. 8124

Patient Collections phone number – 1 800 711 6521

Medical Record Requests need to be sent to – Email:

mdmedical@dmrs.net / Fax (213) 225-5070 / Phone (800) 359-

8520

Patient refurnds

need an allowance period of 30 days to complete processing.

LOCCUMS : Make sure progress note is signed and scanned, the correct template is used

(acute / preventive), if correct template is needed, please ask RDO. Locums should never

see Medicare patients.


How to code new/ established

visits on the same day.

(when the patient is truly a new patient to our facilities)

PAYOR GROUP PATIENT AGE RULE CPTS YOU MAY USE

COMMERCIAL

ALL AGES

Well visits are going to be

billed as a new patient

sick visits billed as if

patient was established

99381 - 99387

99211 -99215

MEDICAID

0 - 20 YEARS

21 YEARS AND

MORE

Well visits are going to be

billed as a new patient

Well visits are going to be

billed as a new patient

Sick visits billed as if

patient was established.

99381 -

99385

99201 -

99205

99385 - 99387

99211 - 99215

If visit is done by a Locum, two separate notes will need to be

attached to the patients file

COVID-19 Vaccines Guidelines

COVID 19 VACCINE TYPE OF CODE CPT AGES

EFFECTIVE

J&J (JANSSEN)

VACCINE

1ST DOSE ADMIN

91303

0031A

18 AND OLDER 2/27/2021

MODERNA

VACCINE

1ST DOSE ADMIN

2ND DOSE ADMIN

3RD DOSE ADMIN

99301

0011A

0012A

0013A

18 AND OLDER

12/18/2020

8/12/2021

PFIZER

VACCINE

1ST DOSE ADMIN

2ND DOSE ADMIN

3RD DOSE ADMIN

99300

0001A

0002A

0003A

12 AND OLDER

12/11/2020

8/12/2021

PFIZER PEDIATRICS

VACCINE

1ST DOSE ADMIN

2ND DOSE ADMIN

91307

0071A

0072A

CHILDREN 5-11 YEARS

OLD

Do not collect from self-pay patients for COVID vaccines and/or Free COVID testing.

10/29/2021

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