MoonSad137
Contributor
I work for a GI physician, who performed a colonoscopy at a local hospital in say March. That colonoscopy was severely limited due to large amounts of retained stool, despite reaching the cecum the entire mucosa was not examined. Medicare determined that the procedure was complete enough (apparently because the cecum was reached).
About a month later the patient had a repeat procedure, this time however; the cecum was not reached due to retained stool limiting the examination, this time doctor was only able to reach the ascending colon because the stool was clogging the scope.
My office obtained an ABN from the patient for the second procedure and it appears the secondary (UHC) is processing the claim for payment.
My concern is the bill the patient received from the hospital, a $4000 bill, since Medicare did not allow the second procedure (it does not appear that the hospital has adjusted the amount due to cash pay). The hospital billing company states they've billed the secondary insurance who also disallowed the charges. It does not appear the hospital obtained an ABN or anything of the sort. When speaking with the hospital's billing it was determined that no modifier was used indicating reduced services on the second procedure or that an ABN was received. I have assisted the patient in filing a dispute with the hospital regarding this. Can they bill the patient without the ABN? This is the first time (that I am aware of) that the hospital has done this to one of our patients.
Any input is greatly appreciated!
Thanks,
BH
About a month later the patient had a repeat procedure, this time however; the cecum was not reached due to retained stool limiting the examination, this time doctor was only able to reach the ascending colon because the stool was clogging the scope.
My office obtained an ABN from the patient for the second procedure and it appears the secondary (UHC) is processing the claim for payment.
My concern is the bill the patient received from the hospital, a $4000 bill, since Medicare did not allow the second procedure (it does not appear that the hospital has adjusted the amount due to cash pay). The hospital billing company states they've billed the secondary insurance who also disallowed the charges. It does not appear the hospital obtained an ABN or anything of the sort. When speaking with the hospital's billing it was determined that no modifier was used indicating reduced services on the second procedure or that an ABN was received. I have assisted the patient in filing a dispute with the hospital regarding this. Can they bill the patient without the ABN? This is the first time (that I am aware of) that the hospital has done this to one of our patients.
Any input is greatly appreciated!
Thanks,
BH