Anthem

Effective October 1, 2019, Blue Cross will require providers to submit their charges within 90 days from the date of service.  It is imperative that RCM get these cases as soon as possible to verify coverage and submit the claim within the 90 day window to avoid any timely filing denials.

GI Cases

We are seeing more GI cases that lack the documentation for billing. We’d like to remind you to do the following when providing anesthesia to a GI case:

  • Submit your cases with the pre and post op diagnoses along with any supporting documentation (i.e. operative report)
  • Work with your gastroenterologists to complete “Medical Necessity Forms” and send those forms to RCM with your charges
  • Get a signed “Fee Waiver Form” from the patient

 

Post-Operative Pain Blocks

It is important to document all post-operative pain blocks appropriately to ensure proper coding and reimbursement.  Many insurance companies consider these blocks “global” with surgery anesthetic and for RCM to appeal these denials, we need documentation.  When possible, document the block on a separate report.  It should be done and documented that the surgeon requested the block and that it is done specifically for post-operative pain management.  Best case scenario, the surgeon has it documented in their report as well.