Question Assisted Living Billing

taminac19

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I have a client that sees patients in AL facilities. They recently switched to us for billing and are using office visit E&M codes for patients seen at the AL facility.
"We were told by our previous billing company that if the Assisted living facility has an office for us to see patients in, it is considered an office visit?" I say no, but they want "proof"
 

csperoni

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My first question would be whether or not they are paying rent for the office space they are using.
If not, then I don't see how it could possibly be an office visit. If yes, then I would look further in depth, and the provider would also need to add that address as an office location for insurance credentialing.
 

SharonCollachi

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Sometimes you cannot find a rule that says what you cannot do, only what you can. Think of it like this... is he renting space from the facility? If this was in a patient's home, and he used an "office" there, would it be an office visit? No.

Check here to see if it should be considered a patient's home and therefore a home visit, a skill nursing facility visit, or a domiciliary visit:
 

taminac19

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Sometimes you cannot find a rule that says what you cannot do, only what you can. Think of it like this... is he renting space from the facility? If this was in a patient's home, and he used an "office" there, would it be an office visit? No.

Check here to see if it should be considered a patient's home and therefore a home visit, a skill nursing facility visit, or a domiciliary visit:
I tried to explain that to them and advised its still in the assisted living facility so the POS does not change. They are insisting that's not the case and even upper mgmt of the company tried to say the same thing. I gave them AAPC page numbers for each E&M section for their reference. They are not renting a space, they are going to the AL to see the patients for care. I appreciate your reply! I wanted to make sure I was on the right track of thought.
 

taminac19

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My first question would be whether or not they are paying rent for the office space they are using.
If not, then I don't see how it could possibly be an office visit. If yes, then I would look further in depth, and the provider would also need to add that address as an office location for insurance credentialing.
They do not rent space at all. They come to these facilities to see patients for different medical issues. These locations are listed on their Medicare profile as places they render services.
 

SharonCollachi

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They are not renting a space, they are going to the AL to see the patients for care. I appreciate your reply! I wanted to make sure I was on the right track of thought.
Yes, you are. Can patients from outside the AL make appointments to see the doctor there? I bet not. Another thing that makes it "not an office."
 
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