Practice Management Alert
New Years Resolutions
Clean Up Preventive-Medicine Claims It's that time of year again the season to nix bad habits. Commit to processing clean annual-exam and other preventative-medicine claims once and for all with tips from expert Betsy Nicoletti, CPC, a consultant with Helms, in Concord, N.H
It's helpful to the receptionist and patients and it speeds up the process if you first send a letter to Medicare patients advising that Medicare doesn't pay for physical exams. The letter could read: "We just want to remind you what Medicare's policy is on physical exams, and when you come in for an annual exam not related to a sick visit, you are responsible for payment." Medicare is cracking down on practices that bill out 99214s and 99215s with a diagnosis or a preventive exam, so do what you can to make clear to all parties Medicare's policy.
The CPT book says that you can bill this way, and its "correct" coding, "but nobody pays it that way," Nicoletti warns. Private payers will deny you on one of the codes, and you can only hope that they deny the lower-value one. For the unpaid code, you will have to make a policy decision about writing it off or going after the patient for payment.
Instead of reporting both codes for payment, you should look at the main focus of the visit and report the code that describes it. If the main focus of the visit was for the preventive, and the physician also treated a minor medial problem such as sinusitis, you should ignore the minor service and just not bill it. However, if the patient comes in for a preventive exam but a chronic problem such as diabetes flares up, consider rescheduling the preventive exam. Youre not going to get paid for the significant work done for the diabetes and the physical exam, so ask the patient to come back for the physical so your physician can devote proper time to the exam and Medicare covers the physical.
Reporting both codes "is going to be a hassle; youre not going to collect it, youre going to appeal it," Nicoletti warns.
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