Wiki Being told to combine all hospital visits on a single claim

carlystur

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I am now being told that I should hold all hospital visits that our doctors do until the patient gets discharged so all of the visits can go out on a single claim to insurance companies because they aren't paying for the individual visits after the initial inpatient visits, apparently. I can ask what the denials are for if you think I should. I am simply a coder here and don't handle those types of denials. This doesn't seem right to me, unless it's like a Super Bill kind of thing, which I have heard about. I would think the proper way to handle multiple visits on different days is to bill them out individually to show the different days they were done. That is the way I had been coding the hospital visits on each individual claim - one for each date of service. Is that wrong or are the billers just trying to get the providers paid for everything regardless of the fact that billing them this way might be done fraudulently?
 
No, you can report multiple days on the same claim (I am talking about pro fee 1500 claim form). For example, if I was coding/following a trauma patient for orthopedic providers I would put multiple dates on the same claim for daily rounding unrelated to a global (e.g. 99232). The line item is what shows the service date. I don't know about holding them, that would seem to be a practice/office choice. Doing this would not make sense as a reason just because, "insurance companies aren't paying for the individual visits". I think there might be some confusion or possibly incorrect codes to cause denial? I have seen it both ways, one date one claim and multiple dates on one claim. I am not talking about facility, UB though. I think you need more information or better guidance to understand the reasoning.

Sometimes it can get really confusing if a patient is admitted and you bill "too fast". You are trying to capture the entire episode of care (again talking pro fee). It can be better to wait and capture the whole thing at once. It can also depend on the way the practice management software being used is set up. There are too many variables and background things that could be going on as to why you are being told to do this.
 
It's not fraudulent to do this. The CMS 1500 form can accommodate multiple dates of service and multiple servicing providers all on the same claim form, as long as all of the providers are employed by the same parent organization billing with the same TIN and group NPI. I doubt that it's going to be a solution to the problem of denials, but if the billing department thinks it will help, and you're not misrepresenting any of the information, I don't see anything wrong with doing it this way.
 
No, you can report multiple days on the same claim (I am talking about pro fee 1500 claim form). For example, if I was coding/following a trauma patient for orthopedic providers I would put multiple dates on the same claim for daily rounding unrelated to a global (e.g. 99232). The line item is what shows the service date. I don't know about holding them, that would seem to be a practice/office choice. Doing this would not make sense as a reason just because, "insurance companies aren't paying for the individual visits". I think there might be some confusion or possibly incorrect codes to cause denial? I have seen it both ways, one date one claim and multiple dates on one claim. I am not talking about facility, UB though. I think you need more information or better guidance to understand the reasoning.

Sometimes it can get really confusing if a patient is admitted and you bill "too fast". You are trying to capture the entire episode of care (again talking pro fee). It can be better to wait and capture the whole thing at once. It can also depend on the way the practice management software being used is set up. There are too many variables and background things that could be going on as to why you are being told to do this.
It's not fraudulent to do this. The CMS 1500 form can accommodate multiple dates of service and multiple servicing providers all on the same claim form, as long as all of the providers are employed by the same parent organization billing with the same TIN and group NPI. I doubt that it's going to be a solution to the problem of denials, but if the billing department thinks it will help, and you're not misrepresenting any of the information, I don't see anything wrong with doing it this way.
Thank you both for your input. Our office providers are able to see patients in certain hospitals that we bill for, apparently. I don't know all of the details, but I believe they are contracted with these hospitals. I don't know much about the pro-fee stuff, unfortunately. We are using eClinicalWorks and I have the Out-of-Office Visits page. I guess I was concerned when I create the Out-of-Office Visit and there's a thing were you enter the Service Date. I had assumed that Service Date meant each individual date the patient was seen in the hospital. So, would the Service Date be the first date that our providers saw the patient that gets listed on the claim as the Service Date and then the follow ups can go on that same claim with their dates of service under SDOS and EDOS? That explanation of "trying to capture the entire episode of care" helped make sense for why I could do it that way, so thank you!

I guess I'm now more concerned about how this will affect my work flow since our other coder is quitting for another place where she can work fully remote when we are only allowed to work remotely under certain circumstances on a case-by-case basis and I'm going to have to take on all (or at least most) of what she did.

Of course, it doesn't help that I had been used to coding Outpatient Office Visits for these same providers and each of those is billed individually. We've been in business for 5 years, but we had been using an outsourced coding and billing company - MScribe - and only within the last year or two did we switch to fully in-house billing/coding. Nor did we have any oversight on how we coded/billed in the beginning. I'm honestly hoping I can go fully into Office/Outpatient visits rather than Inpatient visits.
 
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You're correct - each time the patient is seen in the hospital would get its own service date - you would not use just the first date the patient was seen. The claim, or the 'encounter' in your system might have a range of dates, but each physician service would have its own specific date on the claim. I'm not sure how this works in the system you're using, but the important thing is that is goes out on the claim correctly.

I've seen some providers submit a range of dates with multiple units (for example: 99232 X 4 units with dates 5/1/22 - 5/4/22) but I don't recommend this because it can cause payment errors and I know that some payers will deny the whole claim if it is billed this way. But you can bill multiple lines, each with different dates, all on the same claim.
 
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