Wiki Medicare IPPE-still needing help

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misstigris

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Still needing help with this scenario...
What to do and how to bill when all the requirements are not met?

Example: Patient schedules for IPPE, physician writes that he has performed this service, but in review of documentation, he has not performed all the required elements necessary in order to bill this.

I don't want to just bill 99397 (knowing Medicare will deny it and assign it to the patient). Had thought about billing with a modifier to show reduced services, but heard from the Medicare rep this would be denied as well. I'm almost inclined to bill it this way, and have it be our provider write off....

Any suggestions????
 
my personal opinion is....the patient came in and requested the IPPE, the doctor should have performed all required elements. Its not the pt's fault that the doctor didnt complete the required exam, and I dont think they should get a bill. Educate your physicians about what's required...give them a template! Let them know if the requirements aren't met, you cant bill the IPPE.
 
I completely agree with not billing the IPPE as it wasn't fully done. This definitely is a training/education issue with the physicians... I have given them templates, info from medicare, etc etc... I know that Medicare won't pay for the service if billed with a reduced service modifier (and they shouldn't) but was thinking that if I did this and received the rejection from Medicare, maybe they would pay more attention next time...
 
Our providers still struggle with the gray areas on the IPPE form that are unclear if they're required elements or not. Especially the area regarding end of life planning stating it's a required service, upon the beneficiary's consent. If the beneficiary doesn't consent, I'm assuming it isn't required then and you can still bill the IPPE?
 
kamkole said:
Our providers still struggle with the gray areas on the IPPE form that are unclear if they're required elements or not. Especially the area regarding end of life planning stating it's a required service, upon the beneficiary's consent. If the beneficiary doesn't consent, I'm assuming it isn't required then and you can still bill the IPPE?
Click to expand...

I would say yes, as long as it is documented that the patient did not wish to discusss end of life planning.
 
Medicare-IPPE-still needing help

I have one first thing this morning that the required criteria wasn't met. Would you do this as a no charge? This provider has been educated, he's just being difficult and I don't think this is fair to the patient. Any thoughts?
 
If the patient scheduled an appt. for an IPPE, but did not receive one, we do not charge anything except for ancillary labs and possible an add'l E/M if documentation requirements were met. If the provider did not complete the required IPPE elements, again we would not bill for it.
The patient did not receive what they requested;
 
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