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Sunday, April 17, 2011

NCORRECT BILLING OF ALLERGY SHOTS AND ANTIGENS TOGETHER

ESCRIPTION OF THE ISSUE
Initially we received superbill either marked with Allergy shots (95115 / 95117) or Antigens (95165) along with units marked together for all the insurances. Based on the superbill we started billing both the Allergy shots and Antigens together for the same DOS for patients which is incorrect.

CONCEPT
We are not suppose to bill procedures with combination of Allergy shots and Antigens.  Because Allergy shots could be repeated more than once in a month for the same patient, whereas Antigens would be done only once in a month.

SOLUTION
Incorrectly paid procedures by the carriers were refunded through voluntary refund initiation letters. For which most of the carriers have taken offset in future payments and few insurances forwarded us the refund request letter for further go. And we have filed claims again with corrected CPTs.

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