Wiki Medicare Rejections for different Doctor seeing same Patient.

[K J Harvey]

I work for an Internal Medicine Office and our Doctors see patients at he Hospital. This year we are getting rejected from Medicare for the hospital visit because other IM doctors seen them the same day. When researcing the information I found that the specialist also do IM in there practice. So I appealed the rejection and now they denied it because the other Doctor billed first but they seen the patient as a consult for cardiology not IM. I do use the AI code that medicare said to use as the primary care intial visit. Can anyone give any suggegtion on how I should bill it.

Thank You
KJ Harvey

 

[Herbie Lorona]

I have had the same problem a while back with a few patients. The cardiologist was also showing as a Internal Medicine. I had to send it in as a appeal with all the notes. They denied that and I had to do a second level appeal and they also denied that. I had a hearing scheduled for one of them and before the hearing the file had been updated for the cardiologist and got the claim paid. The other one I went through the hearing and ended up getting paid after it.

 

[penguins11]

I have had the same problem as well. I would file an appeal with all the notes and specifically point out in your appeal letter the need for both dr's to treat the patient and point out what problems the different dr's treated. We have had success with these appeals but you have to point out for them in your letter what problems each treated.