Sanfos2013
New
Provider insist on billing a 99309 with a future DOS that has not occurred yet. Can someone direct on documentation for this? Thank you!
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Billing DOS that have not occurred yet
- Thread starter Sanfos2013
- Start date
No - that would be completely inappropriate.
You shouldn’t bill until the documentation is complete. How would he document a skilled nursing facility visit that hasn’t even occurred?
Subsequent SNF visits have multiple possible levels, and he can’t guarantee that 99309 will be the correct code. It could easily be a lower level (99307 or 99308) or a higher level (99310), depending on what actually takes place during the encounter.
And beyond that, there are countless scenarios where the visit may not happen at all - the patient could be discharged earlier than expected, the patient could expire, the physician could be unavailable, or the visit could be canceled for other reasons.
Sanfos2013
New
It is beyond frustrating! This seems very obvious but he is insisting. Thanks for your input!
Honestly, even if you tried, the system is going to give a warning that it is an invalid date anyhow.
I have accidentally selected a future date when manually entering a claim before. (For example, trying to enter a missed claim that had a DOS for the prior year and accidentally putting in the correct date with the current year.) Our billing system gave me all kinds of warnings and error messages, and wouldn't even let me submit it. Which, of course, I appreciated because I could correct the year and submit correctly.
And, if for some reason your billing system didn't prevent you from entering it, your clearinghouse and/or the insurance company would almost certainly reject it.
Pam Warren
True Blue
I'd recommend you print out this Medicare Med Learn Matters document (link above) and set it on your provider's desk. In particular:
Medicare fraud typically includes any of the following: Knowingly submitting, or causing to be submitted, false claims or making misrepresentations of fact to obtain a Federal health care payment for which no entitlement would otherwise exist.
Knowingly billing for services not furnished, supplies not provided, or both, including falsifying records to show delivery of such items.