• 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 the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Established visit vs. Establishing Care visit

Create Wiki Sort by votes
K

kelly.kirkman@icloud.com

New
Messages
4
Location
Hallettsville, TX
Best answers
0
I work for a small Rural Health Clinic. Our hospital and clinic fall under the same tax ID but have different NPI numbers. Commercial payers, mostly BCBS, have been sending quite a few level of care denials related to clinic office visits. For instance, a patient comes into our clinic for follow up after a visit to the emergency room, and also to establish care. The correct coding for this situation would be an established visit. However, since the patient was already seen in our emergency room, insurance will reduce the level of service saying we can not bill for an establishment of care visit and it has to be coded as a regular visit. This also causes issues with our visiting physicians who see patients in our clinic who have been referred to them by doctors of our clinic.

Does anyone have any advice on this situation?
 
You must log in or register to reply here.
Top