No Surprises Act (NSA), Federal IDR, and how does it work?
The 2020 No Surprises Act (NSA) established new federal protections against surprise medical bills and balance billing, which took effect on January 1, 2022.
For emergency patients visiting a hospital or freestanding...
The No Surprises Act (NSA) and What It Means for Emergency Rooms
The 2020 No Surprises Act (NSA) established new federal protections against surprise medical bills and balance billing, most of which took effect January 1, 2022. Below is a summary of the...
Ultrasound CPT Codes 2022
Diagnostic Ultrasound Procedures CPT Code range 76506- 76999. The Current Procedural Terminology (CPT) code range for Diagnostic Ultrasound Procedures 76506-76999 is a medical code set maintained by the American Medical Association.
Ultrasound...
Understand and Recognize the Types of CPT Codes 2022
What are CPT Codes?
Current Procedural Terminology, more commonly known as CPT codes, refers to a set of medical codes used by physicians/providers, non-physician practitioners, hospitals, outpatient facilities, and laboratories to describe...
CO 6 Denial: The procedure code is inconsistent with the patient’s age
CO 6 Denial Code: The procedure/revenue code is inconsistent with the patient's age
When the claim says CO 6 Denial Code – The Procedure/revenue code is inconsistent with the patient’s age, it...
Denial Code CO 204 – Not Covered under the Patient’s current benefits
Denial Code CO 204 - Not Covered under the Patient's current benefits plan
With a valid Advance Beneficiary Notice (ABN):
PR-204: This service, equipment and/or drug is not covered under the patient's...
Updated List of Freestanding Emergency Rooms in Texas
What is a Freestanding Emergency Room?
A freestanding emergency department (FSED) is a licensed facility that is structurally separate and distinct from a hospital and provides emergency care.
The Texas Freestanding Emergency Medical...
CO 119 & PR 119 – Benefit Maximum for this Time Period has been...
(MEDICARE DOES NOT PAY FOR THIS MANY SERVICES OR SUPPLIES)
CO -119 Benefit maximum for this time period or occurrence has been reached.
Check Benefit Information through website/Calls
If NO - Call the carrier...
Insurance denial CO 39: Authorization/Referral Problem
Insurance denial CO 39: Services denied at the time Prior authorization/pre-certification was requested
Some carriers insist on obtaining prior authorization from them before the surgery. This may be for certain specific procedures...
Denial Code CO 47: Diagnosis Missing or Invalid
Denial Code CO 47: Diagnosis Missing or Invalid
Insurances Company will be denying the claim with CO 47 Denial Code: This (these) diagnosis (es) is (are) not covered, missing, or are invalid,...