News & Events

Acupuncture Claims

Acupuncture is a safe ancient form of Chinese medicine received by millions annually.  According to the National Institutes of Health reports that acupuncture is one of the most common forms of alternative medicine covered by insurance.

120216-N-PB383-414 ARABIAN GULF (Feb. 16, 2012) Cmdr. Yevsey Goldberg conducts an acupuncture procedure on a patient aboard the amphibious transport dock ship USS New Orleans (LPD 18). New Orleans and embarked Marines assigned to the 11th Marine Expeditionary Unit (11th MEU) are deployed as part of the Makin Island Amphibious Ready Group, supporting maritime security operations and theater security cooperation efforts in the U.S. 5th Fleet area of responsibility. (U.S. Navy photo by Mass Communication Specialist 2nd Class Dominique Pineiro/Released)

During the first session, a practitioner inquires about the patient’s health and medical history, and examines the pulse and tongue. Practitioners ask about the medical ailments the patient hopes to treat and medications currently taken. Fees for an initial medical consultation and an acupuncture session where thin, sterile needles are inserted into pressure points in the skin, should be paid for with a medical claim.

During this session the practitioner also determines the appropriate number and duration of follow-up visits to treat the medical condition. Costs are similar nationwide and don’t vary greatly between clinics and private practitioners. Fees for an initial visit range from $75 to $95. Routine visits cost $50 to $70.  

Many practitioners recommend patients take specialized Chinese herbs, such as ginseng and gui pi wan, that are designed to supplement the acupuncture. These types of supplements may not be covered under medical claims.


While clinic practices vary, some practitioners also accept gratuities of 15 to 20 percent of the bill. Gratuities are generally not paid and not considered compulsory. For a claim to be fully paid, there must be an appropriate diagnosis to establish the medical necessity of the procedure.

Coverage for any claim should be verified before treatment from a clinic or private practitioner. Verifying coverage and communicating clearly with the patient regarding essential and optional services can minimize concerns and ensure claims are processed timely. Contact us today at Apex EDI and we can help you with your claims today!

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.


Posted in: Acupuncture, Acupuncture Claims, Apex EDI, Resources

Leave a Comment (0) →

Ophthalmology Claims

As an ophthalmology professional, you must ensure all claims are submitted properly to ensure your business continues to run smoothly. Here are a few general tips to make sure claims are both accurate and timely.

an eye

First, as with any claim, be sure to obtain and verify all of the necessary patient and provider information. Accurate information allows claims to be processed and paid without delay. It’s also important to submit claims promptly with all supporting documentation. Check the claim prior to the final submission to be sure that it is error free. This will help minimize stress that can be caused by claims that are coded or filed incorrectly. Common errors such as failing to submit a quantity of 2 to obtain payment for both eyes, or not indicating the correct modifier for the procedure performed can lead to weeks of delay.

Vision plans cover routine wellness exams for eye health. Medical eye care, on the other hand, is for the treatment of specific medical conditions related to the eye, such as pink eye, cataracts, or double vision. The diagnosis and treatment for these conditions should be billed through the medical eye care insurance. You’ll want to ensure that you are billing the correct insurance to receive payment promptly.

Following these simple steps when filing an ophthalmology claim, will increase the efficiency in your office and ensure you receive payment from payers in no time. Apex EDI can help ensure the best possible care for your patients by verifying vision and medical claims before they are sent to the payer for final submission. Apex EDI works to get you paid faster.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

Posted in: Opthamology Claims

Leave a Comment (0) →

Dental Claims vs. Medical Claims

There are some similarities between preparing dental claims and medical claims. For example, patient and insurance demographics and insurance information that must be provided to medical carriers are similar.

However, there are some very significant differences between the two. While dental carriers typically require a procedure code. Medical carriers not only require procedure code(s) but also the reason why the procedure(s) were performed or the patient’s diagnosis.

Diagnoses are classified in code form in the ICD-9-CM “International Classification of Disease, Ninth Revision – Clinical Modification” manual. Without at least one diagnosis code that supports the procedure(s), the medical claim will not be paid. There must be an appropriate diagnosis to establish the medical necessity of the procedure. This is probably the most important part of successful dental-medical cross coding.

Another very significant difference between dental and medical coding systems is the time period and frequency between updates, deletions and revisions. All medical code sets update yearly and medical carriers generally offer no grace periods on using outdated codes.


The medical claim form also has some major differences compared to the dental claim form. Most medical carriers require the CMS-1500 (08-05) claim form. Medical carriers require these preprinted, red-inked forms because these forms are the only ones that scan correctly. Hand-written claims and comments or copies are not accepted.

Apex EDI can provide the best medical electronic billing for all of your medical claims and dental claims. The main benefit to implementing a dental-medical cross-coding system is satisfied patients who recognize your willingness to help them save their dental plan allowance and access medical benefits. Grateful patients can become your most valuable marketing asset.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

Posted in: Dental, Dental Claims, Medical Claims

Leave a Comment (0) →

How to Reduce Podiatry Claim Denials

Denial of a podiatry claim is at best, upsetting for the doctor and staff. At worst, it’s an unexpected cost, which if ignored and continually repeated over time can reduce the value of your business. Taking the time to correct these errors and educate staff will lead to proper payments in the future. Long term will reduce the stress associated with billing corrections, increase revenue and decrease one’s audit exposure. There are 8 common billing mistakes, which corrected can improve the growth of your business.

1. Incorrect CPT-ICD-9 Codes

It’s essential that each individual CPT code correctly aligns with a proper ICD-9 code. If a patient has more than one condition, several ICD-9 codes may be required. Be sure to check with the carrier about which codes are allowed.

2. Physical Therapy

Always check with the carrier for benefits, deductibles and policy limitations before proceeding with providing physical therapy treatments. The order should list the diagnosis, treatment modalities, frequency of treatments, goals, and the expected duration. Never submit claims for modalities that patients can apply or use themselves.

spooky foot

3. X-Ray Reimbursement

Only take the number of x-ray views medically necessary and reasonable. Also, ensure thorough documentation of all x-ray views taken. Be sure to use appropriate diagnosis codes for an x-ray service.  

4. Durable Medical Equipment (DME) Documentation

Generally, home is the proper place of service (POS).  To ensure accurate reimbursement this must be submitted correctly on the claim form. Always verify the HCPCS code with the DME carrier and be sure to explain the various options for obtaining DME to patients along with the financial implications.

5. Surgery

It’s important to verify prior to surgery whether or not prior authorization is required. Check with each carrier about the software it employs to bill properly for the services performed. The proper use of modifiers is also very important.   

just feet

6. Routine Foot Care

Due to the multiple Medicare carriers, coding for routine foot care that raised blood pressure can be very confusing. Be careful to clearly list and align at-risk conditions and painful conditions with the appropriate ICD-9 codes on the claim form.  

7. Evaluation and Management (E/M) Coding

Use of the 25 modifier is a common area of confusion. Make sure to use this modifier only when indicated.

8. Casting Reimbursement

When a cast is applied at the time of surgery, it is included in the surgical allowance and is not payable separately. Supplies are only payable with a diagnosis of a fracture or a dislocation.

It is important to continually monitor one’s billing practices. Being aware of new changes in policies and learning from errors can go a long way toward avoiding repeat claim denials.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The above is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about.

Posted in: Podiatry Claims

Leave a Comment (0) →

The Benefits of Partnering with Apex EDI

Apex Logo
We at Apex EDI are the leader in private label claims delivery. We created a One Touch Solution to offer you a secure, easy, and inexpensive way to process your private insurance claims electronically.

Within two weeks, we will improve your bottom line by lowering the cost of claims processing, providing faster reimbursement to your clients, and increasing your access to healthcare payers. You’ll never have to worry again about client satisfaction with our state of the art service.  You’ll have the ongoing support of our friendly and knowledgeable staff always standing by 24/7 to answer questions and solve problems.

Partnering with APEX EDI is completely stress-free. We provide a generous revenue sharing program, free training and ongoing, automatic compliance updates. Our experienced team will handle once expensive and time-consuming upgrades for you. You will be able to load and send claims directly from the APEX One Touch or your own practice management software. You will have instant access to your account from any computer with Internet access. Through our secure partner portal, you’ll find co-branded marketing materials, customized client reports and the expertise of our support team.


We’re confident that we can add value for your business and increase your customer satisfaction. There simply isn’t another claims clearinghouse partner that can match our level of support. You won’t regret adding the most powerful set of practice tools available to your business. Contact us today to tell us about your business needs and schedule a free demonstration.  

Articles with this disclaimer were not written by Apex EDI.

Posted in: EDI, Medical Claims, News, Resources

Leave a Comment (0) →
Page 4 of 22 «...23456...»