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I would apologize to him again and again
and try and make it right with the insurance company.  I would try and
explain that I would do everything in my power to try and fix it with
the insurance company.  It should have been a V code with the insurance

I would for sure contact the insurance company and tell them I made
an error with the coding and and I could have them try and correct my

I would try and assure the patient that this mistake would never happen again and apologize again and again.


It is Friday September 30, 2012, and you are having lunch with a
friend who works at another physician’s office.  During the course of
the conversation, she asks you if your office is ready to handle the
ICD-10 transition from ICD-9 Diagnostic coding.  You look at her with a
blank stare and ask, “What transition?”  She explains how everything is
going to change, including the format and number of digits.  You realize
that since the medical billing specialist left for maternity leave six
weeks ago, that no claims have gotten billed.

  • What process will you take to get those claims filed? 
  • Is there time before Monday when the change takes effect?
  • Oh no, will it be better to electronically file the claims over the
    weekend in the ICD-9 format; Go thru a clearinghouse; or print
    everything out on paper, hoping the claims will be considered under the
  • ICD-9 format and not under the ICD-10?
  • Explain your choice.

Your office recently decided to stock braces and crutches as you had
anticipated an increase of patients coming in with sprains and fractures
of body parts as summer was right around the corner and your physician
wanted to service the patients better by not having the patient drive to
multiple places for those Durable Medical Equipment (DME) items.

However, you noticed that denials are coming in from Medicare. 
Medicare Remittances are stating that they are not the payer.  However,
you pull the patients cards and see Medicare very clearly on their
cards. What actions would you take to find out which payer is
responsible for the Durable Medical Equipment (DME)?  Your physician is a
Participating provider with Medicare.  What is the problem?  Why is Medicare not paying? 

  • Define the steps you would take to find out why Medicare is not paying and how you would solve the problem. 
  • What steps need to be taken? 
  • Who is supposed to be the payer? 
  • How do you get the claims to that payer?
  • Does any other paperwork need to be completed?  If so,what?

This is 3 Dqs Question Number is is a long question so it goes all together.

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