Wiki Balance Billing Past Timely

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sparkles1077

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Hello Fellow Coding Gurus,

So my mom has Medicare/Tricare and recently decided to get a second opinion. She requested records from the PCP (who required a $50 fee to distribute) and interpreted the request as transferring care. They decided to slap her with a $200 bill for a G0439 service that was not paid by Medicare (Though Medicare did pay the 99213 for a same day e and m). The date of service was 5/30/2013 and she is just now getting the bill from the PCP. They are also charging interest. I can not imagine that this is correct billing. Of course, I submitted an appeal but it is past timely filing as we did not know this bill would be on her. Can someone advise me of best action here? I don't think this practice should get away with this kind of patient treatment. I have already discussed my concerns with the practice

Thank you

Sparkles
 
sparkles1077 said:
Hello Fellow Coding Gurus,

So my mom has Medicare/Tricare and recently decided to get a second opinion. She requested records from the PCP (who required a $50 fee to distribute) and interpreted the request as transferring care. They decided to slap her with a $200 bill for a G0439 service that was not paid by Medicare (Though Medicare did pay the 99213 for a same day e and m). The date of service was 5/30/2013 and she is just now getting the bill from the PCP. They are also charging interest. I can not imagine that this is correct billing. Of course, I submitted an appeal but it is past timely filing as we did not know this bill would be on her. Can someone advise me of best action here? I don't think this practice should get away with this kind of patient treatment. I have already discussed my concerns with the practice

Thank you

Sparkles
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If the practice did not bill the G0439 then they cannot bill the patient especially since this code is 100% paid by Medicare. So the question is why did they bill a 99213 on the same date of service. And did they bill both and the G0439 denied? You need to contact Medicare and find out exactly what codes were billed, diagnosis and procedure
 
I concur with Mitchellde regarding the statement she received for G0439. I would call Medicare and ask them how they processed that claim and why they did not pay it. If the claim was processed with a CO code, your mother is not responsible for the charge. Regarding the charge for the records; this is from www.hhs.com: a provider may charge for the reasonable costs for copying and mailing the records. If you go to www.lamblawoffice.com there are hyperlinks to each state's fees that can be charged for medical records.
 
Thank you for the help. I am sorry, I was not clear about the initial billing. The provider billed G0439 for well woman and 99213*25 for shoulder pain. Medicare paid the 99213, but denied G0439 back in August 2013. She was eligible for the service and the provider did obtain eligibility. We did not receive a bill for this until just a couple of weeks ago, when my mom went to request medical records be sent to another provider. I feel this is unfair, as it is now late for an appeal.

There are no CO codes, just a denial saying benefit maximum was reached (PR 119) but again she was eligible. I went through all claims myself and she was eligible for G0439. However, it is late too appeal so the frustration the provider deciding to bill patient a year later.

Thank you again
 
Provider billing error, if claim was denied they need to w/o. Also, you cannot charge interest to a Medicare patient.
 
I agree this is incorrect billing by the provider. If the purpose of the visit was a second opinion for your mom, then the 99213 is correct and the G0439 should not have been billed. It doesn't sound like your mom went for a well visit, just a second opinion. Request the office note and see if the documentation supports billing both codes (I suspect it doesn't). Your mom should contact Medicare to dispute the G0439 charge if she was not there for that reason.
 
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