I have been receiving HMS audit (NV Medicaid) stating that they overpaid the providers (Palliative Care) because we billed initial inpatient codes (99221-99223) when our providers were not the admitting provider. They are stating that only the admitting provider could bill for the initial inpatient visit and our specialist (first time seeing the patient) should bill the subsequent level codes (99231-99233). I requested for them to direct me to where it states this in their guidelines and they were unable to do so. They stated that they are following the AMA guidelines.
I sent them a rebuttal letter, quoting the AMA guidelines:
An initial service is when the patient has not received any professional services from the physician or qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subsequently who belongs to the same group practice, during the inpatient, observation or nursing facility admission and stay.
Our providers are not from the same specialty, but they still upheld their decision and are requesting money back.
Has anyone else experience this with Medicaid? Do other provider specialties bill subsequent visit codes for the initial inpatient visit for your providers, even if they are not the admitting provider?
I sent them a rebuttal letter, quoting the AMA guidelines:
An initial service is when the patient has not received any professional services from the physician or qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subsequently who belongs to the same group practice, during the inpatient, observation or nursing facility admission and stay.
Our providers are not from the same specialty, but they still upheld their decision and are requesting money back.
Has anyone else experience this with Medicaid? Do other provider specialties bill subsequent visit codes for the initial inpatient visit for your providers, even if they are not the admitting provider?