WebPT Ideas and Discovery

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Rulesets for Specific Payers

Some payers won't pay on certain combinations of CPT codes, claiming that it's bundling (97530 and 97140, e.g.).  Most payers will pay on all the line items in these instances when the proper modifier is used, however some pesky plans like Humana and Aetna will still refuse.  They arbitrarily choose which CPT to pay and which to deny, and our reimbursement suffers.  So for those two plans we have to adjust our CPT codes if the therapist forgot to bill it properly.  In our old system our billing manager was able to double check these claims before submitting a batch each morning, but in Therabill no such check occurs because claims send automatically after submitting electronically.  I would love for there to be a way to apply a ruleset to a specific payer that prevented a claim being sent if both the CPT codes 97530 and 97140 happened to populate one claim.

  • Guest
  • Jan 2 2020
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