Anesco North Broward

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Attention: Blue Cross Insureds

This notice concerns claims denied by Blue Cross for "duplicate claims" or "already processed." If you have recently received a statement from our office regarding services that may have occurred during the year (S) 2005-2006, we suggest you contact BCBS carrier directly to dispute balances due.

A word about Anesthesia Billing and Services.

All anesthetics in the United States are performed by either an anesthesiologist (Physician) or an anesthesiologist in conjunction with a Certified Registered Nurse Anesthetist or CRNA. Regardless of who administers the anesthesia, the charges are the same (SEE BELOW EXAMPLE)

If physician solely performs the service, your carrier will receive a one-line claim for the full charge billed with an "AA" modifier (example A). The charge is then discounted to the contracted rate. You, in turn are responsible for any co-pays and deductibles.

In the event the Anesthesia Care team (physician and CRNA) performs the service (example B), your carrier will then receive a claim with two-line items, one for each provider billed with a "QK, QY and QX" modifier. However, each provider bills for one half the charge. We do this because of Medicare and/or your carrier's regulation. IN EITHER EVENT, THE TOTAL EXPECTED PAYMENT IS THE SAME; YOU ARE NOT BEING DOUBLE BILLED.

In this example, both methods would allow the same amount- $200.00.

EXAMPLE BILLING:

Charge	Provider Information	Allowed Amt	Total for Claim
A. 8/23/06 00840 AA $ 418.00	JOHN DOE, MD BCBS PROV # 12345	$200.00
Claim A. Total	MD only		$200.00-
B. 8/23/06 00840 QX $ 418.00	L SMITH, CRNA BCBS PROV # G6789	$100.00	-
B. 8/23/06 00840 QK $ 418.00	JOHN DOE, MD BCBS PROV # 12345	$100.00
Claim B. Total	MD/CRNA Team	n/a	$200.00

Our office staff has put a considerable amount of time and effort to resolve your issue with your Blue Cross carrier. We have followed all claims procedures appropriately and have appealed denials for "duplicate claims," on your behalf. At this time, if we are still receiving denials, we consider our efforts on your behalf to be exhausted. The balance of the claim is now your responsibility. You may either pay the amount owed or contact your insurer directly. Ask them to review a paper copy of the line items of the claim and point out to them that QK, QY and QX modifiers are separate and payable claims. These modifiers may not show up in their systems, but will show on an imaged claim.

You may contact us at 954-703-2920 or for a faster result, by e-mail at blue@anesco.net. Include your name and account numbers and the issues as you see them. Our goal is to have your claims paid in an appropriate manner; however, the responsibility for payment is ultimately yours.

Thank you for you cooperation.