MDMG Billing Newsletter January 2022

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

R E M I N D E R S
Please be sure we are verifying benefits on
all patients as well as collecting co-pays,
deductibles and/or coinsurances at the time
of the service. (please use Master Fee
Schedule for collecting deductibles / coinsurances)
If employee is coming for OV chose
"Employee Fee Schedule" and adjust $0.01
under employee adjustment only. Do not
adjust any other service done, charges from
"Employee Fee Schedule" are already
adjusted and should be collected when
performed.
If patient with insurance signs the "Self-Pay
Form" please remove insurance from claim at
the time of creation.
When verifying benefits make sure the
provider is linked to Topcare Medical
Group Inc.
If patient has an outstanding balance, please
collect balances based upon our payment
arrangements and/or call CBO to resolve with
patient collections (ext. 8124)
Please remember to update patient's
information such as address and telephone
number. Please update Medicare patient
accounts with their new identification cards.
If patient has a Dual Plan please make sure
you use the presentation provided "Dual
Policies" to verify insurance and load
correct Medicaid and Medicare plans.
Please verify patient's benefits through TMHP
and payor's portal every time a patient
returns to clinic.
CHC when performing CPT 17340 we must
obtain authorization prior to performing.
Superior Ambetter - When performing a
Sports physical, please verify benefits to
know if this is a covered benefit.
Amerigroup has finished loading
Amerivantage to our providers. You can call
Amerigroup and they should be able to
change PCP.
All Medicaid Insurance needs to be verified
on the 1st of every month.
Make sure that for children the
demographics contain
GUARANTOR/Responsible party. We are
seeing numerous account where this is
missing.
If the patient has BCBS HMO then they
should not add BCBS PPO to the patients
account but add BCBS HMO insurance
record.
All HMO’s staff should be updating PCP to
our provider treating patient at the time of
service.