Wiki G0439 denied as charged too soon - bill patient?

[tlwhlw]

I have received denials for G0439 being charged out too soon. The provider wants the charges billed to the patient. I have searched Noridian Medicare website for any info regarding this and not finding anything. Any advise for this?

Would it be appropriate to correct G0439 to an E/M code, 99212 - 99215?

I'm pretty sure the patients are going to be very upset if they get a bill for this, as they are aware Medicare covers this visit, if it's completed correctly. If you have something in "black and white" that I can show the provider that would be helpful! Thank you!

 

[thomas7331]

Your explanation of payment from Medicare will state specifically whether or not your patient owes a balance for which you may bill them. It's important that your billing align with the explanation of payment because the patient also receives a corresponding statement from Medicare which will tell them exactly how much the provider is allow to bill. Typically in a situation like this, where a service is covered under certain instances but is denied due to the specific information billed, Medicare will deny with no patient responsibility and not allow the charges to be billed to the patient unless you have obtained an ABN and submitted the claim with a modifier to indicate this.

 

[tlwhlw]

Thank you for the information....very helpful!