Wiki Home Visit billed as an Office Visit

[Austin2477]

My provider would like to start billing Home Visits as Office Visits. They have had a couple of other providers come to their home and say “my office is wherever I am”, and this helps them get around the insurance not paying the claim. Has anyone else heard of this practice, and is it something we can do?
Thank you!

 

[thomas7331]

An office is a location that a provider either owns or rents. In other words, it’s a place of business that represents an expense to the provider, an expense for which that provider is compensated when billing an office POS. Unless the patient’s is renting out part of their home for the provider’s use, then it can’t be considered the provider’s office.

The provider can say “my office is wherever I am” but I doubt that CMS other other payers would see it it that way if they audited the records. You should gently remind your providers that intentional falsification of information on a claim in order to obtain a payment to which they are not entitled to could be considered a criminal act of fraud. Just because someone else is doing it doesn’t mean it’s a good idea.

 

[lgardner]

The home visit CPT codes (99341 - 99350) are the E/M codes that providers are to use when the patient is seen in their home.

Since these are specific to Home visits, I don't see how it would appropriate to bill outpatient E/M codes instead.

ALSO, please note that when using the home visit codes, travel time cannot be included, when determining the Level of Service based on time.