Good day. I need some assistance finding billing guidelines that state specifically that you can not bill for a receptionist encounter. An individual presented a plan for Care Coordination services to a medical facility in the area. They preposed that an encounter be created for every telephone call that could then be billed to insurance/patient. These are receptionists handleing calls for medication refills, scheduleing follow-ups, and what I thought was considered to be Courtesy Calls. Along with that, Medical Assistants calling patients about refferals and scheduleing as well. I only have a CPC, and CPB at this time while the presenter has multiple certifications but I am to convinced this is not allowed. I need specific guidelines from AMA about what a courtesy call is, and the opinion of a Auditor about such a service being billed.
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki Billing Receptionist Encounters?
- Thread starter taki262@yahoo.com
- Start date
catherinetinkey@entmedicalservices.org
Networker
The only way those would be billable to insurance would be non medical staff started the encounter and clinical staff (physician, PA, ARNP) actually finished the encounter with the patient which included some type of medical situation that was billable. It would truly be such a waist of time to create an encounter for every phone call. I would first check with your insurance carriers see if any of them pay for a "non medical" phone conversation made by an office staff member.
jkyles
True Blue
- Messages
- 1,204
- Best answers
- 1
I think this is a situation where you need to look at the full descriptors for whatever services you're planning to bill and see if they match work the practice wants to bill. I'm not sure there is a pat "Don't do this" anywhere, but I'm willing to bet you can't. For instance, I can't think of a situation where a call to the patient (vs a call from the patient) is separately billable. (Care management comes close but that's a monthly charge for work by clinical staff.)
It's also important to note that reimbursement for services includes associated non-clinical work, such as scheduling or calling in prescriptions. It seems that trying to submit a separate claim is a form of double-dipping.
And assuming there's a payer that covers this, I'd also say the practice needs to think about how patients will respond when they're suddenly getting bills for scheduling an appointment or because someone called in a prescription.
It's also important to note that reimbursement for services includes associated non-clinical work, such as scheduling or calling in prescriptions. It seems that trying to submit a separate claim is a form of double-dipping.
And assuming there's a payer that covers this, I'd also say the practice needs to think about how patients will respond when they're suddenly getting bills for scheduling an appointment or because someone called in a prescription.
amyjph
True Blue
Some concierge practices are like this if it's a cash pay practice and not insurance. There are also some that charge "administrative fees". Once you start talking billing to insurance and/or government payers, the waters become muddy. You have to know what is in the contract and if it is even allowed. This would require some really high level input from the C level, compliance, and probably the rev team. State law may come into play. There better be a super-solid policy and procedure for this. Patients should be well informed about it up front. It is a recipe for disaster otherwise. As suggested above, read the full CPT sections, that is your AMA info. You will see the key words physician or other qualified health care professional (QHP) and clinician. The rules and info are in the telemedicine section of CPT. There are also other codes in the care management section but I'm not sure that's what you are speaking of here. It depends on the type of facility and practice along with the CPT codes they were talking about.
If I was a patient being charged for a simple phone call to schedule, my next call would be to cancel and not go there; unless it was concierge and I knew I was paying for it upfront.
Sure if some outside presenter or consultant comes in and starts talking dollar signs by charging for this stuff, the place may be ready to start doing it, beware... It's the same idea as when a "new", outside EMR vendor comes in to market and tries to show how their "system" can "help you code" all level 5s.
Some articles and info. Just a google search, I am not advocating one way or another.
https://www.medicaleconomics.com/view/nonbillables-when-should-patients-pay-them (from 2003, but good points)
https://www.aafp.org/pubs/fpm/issues/2004/0700/p43.html (2003)
MGMA is a good resource for info. Example: https://www.mgma.com/getkaiasset/42.../2023 MGMA Regulatory Burden Report FINAL.pdf
https://www.americanhealthlaw.org/c...liance-corner-billing-patients-administrative (2022)
If I was a patient being charged for a simple phone call to schedule, my next call would be to cancel and not go there; unless it was concierge and I knew I was paying for it upfront.
Sure if some outside presenter or consultant comes in and starts talking dollar signs by charging for this stuff, the place may be ready to start doing it, beware... It's the same idea as when a "new", outside EMR vendor comes in to market and tries to show how their "system" can "help you code" all level 5s.
Some articles and info. Just a google search, I am not advocating one way or another.
https://www.medicaleconomics.com/view/nonbillables-when-should-patients-pay-them (from 2003, but good points)
https://www.aafp.org/pubs/fpm/issues/2004/0700/p43.html (2003)
MGMA is a good resource for info. Example: https://www.mgma.com/getkaiasset/42.../2023 MGMA Regulatory Burden Report FINAL.pdf
https://www.americanhealthlaw.org/c...liance-corner-billing-patients-administrative (2022)
jkyles
True Blue
- Messages
- 1,204
- Best answers
- 1
A final thought to address what I think is the core issue:
If a practice is looking for ways to generate revenue it can be worth it to bring in a revenue cycle management professional to look at all aspects of the practice and make reasonable recommendations. For example, many consultants I talk to say that practices lose a lot of money because they don't follow up on denials.
If a practice is looking for ways to generate revenue it can be worth it to bring in a revenue cycle management professional to look at all aspects of the practice and make reasonable recommendations. For example, many consultants I talk to say that practices lose a lot of money because they don't follow up on denials.
TThivierge
True Blue
Taki
Ahh you cannot bill for secretaries or admin staff checking up on patients or cancelling patients. You can self pay charge patients for NOT KEEPNG APPOINTMENT a fee but that is to the patient not the payer. Also must have in agreement and inform the patient if not cancel appointment in 24 hours, then be charged. I think Jkyles and Amyjph make good comments on review the revenue cycle on coding, billing, compliance process in office, payer contracts and documentation to find loss funds
I hope this helps you
Lady T
Ahh you cannot bill for secretaries or admin staff checking up on patients or cancelling patients. You can self pay charge patients for NOT KEEPNG APPOINTMENT a fee but that is to the patient not the payer. Also must have in agreement and inform the patient if not cancel appointment in 24 hours, then be charged. I think Jkyles and Amyjph make good comments on review the revenue cycle on coding, billing, compliance process in office, payer contracts and documentation to find loss funds
I hope this helps you
Lady T