Wiki Doctor indicates "No Charge" E/M visit

[skrautkramer]

Can anyone tell me what the billing and coding guidelines are on "no charge" visits and where to find them? For example, if a doctor sees a patient to discuss a few things and they write "no charge" on the encounter and the office staff tell the patient there is no charge for the day, can the billing staff then still decide to code and bill the office E/M visit? Are there guidelines indicating that this should be billed?

 

[SharonCollachi]

I would consider it to be very bad office policy for the billing staff to bill a visit after the patient was told there was no charge.

You can code a zero-dollar visit and not bill it, for record-keeping purposes.

 

[csperoni]

I agree with Sharon. I would not bill it after the patient was told it would not be billed. Why would the billing staff override the provider's decision? You may want to discuss with the provider if this is not just a very occasional situation. Most offices create an internal code for this scenario.

 

[whittiany_ciecchi@yahoo.com]

If service was discontinued by either patient or provider and no medical decision making is made for the evaluation or management of the patient it is best practice to have a process in place to select a practice/compliance created code in place that can be found easily by providers for a "No charge" that can populate for billers to recognize and verify that no codable/billable service was provided and the claim can be zero/done all. In other cases when a provider is providing a global service, pre/post op care etc. then the correct coding and modifier(s) should be applied to indicate all circumstances related to the service provided.

 

[Pam Warren]

Any failure to bill for a service that was provided could be considered a violation of the anti-kickback statute, where you are offering a service without financial expectation (or providing financial incentive to choose you as a provider by adjusting charges in a random fashion). What you want to make sure you do is to have a solid practice policy in place that very clearly defines when you provide a no-charge visit (i.e. surgical global days), what types of financial aid policies you have that would consider (such as a 25% discount for self-pay patients paying by cash on the DOS), and then you have to apply this policy consistently across all lines of business for all patients. The contracts you sign to participate with insurance companies clearly note that you are expected to bill for services you render to their insured, collect copayment, bill correct claims, adjust as they are adjudicated and bill patients when the payer indicates you are to do so. Anything outside that, done randomly, seemingly haphazardly, can land your practice in hot water.