Mva and sick visit on same day

cheri725

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I have a patient that came in for neck pain related to a motor vehicle accident and was also diagnosed with pneumonia. The physician charged a 99213. Who should I bill for this service the medical insurance or the auto? Can I somehow split the charge into two seperate services to cover both problems? :confused:
 

DGWILSON

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MVA and sick visit

The sick visit should be billed to the regular insurance carrier as a separate charge. We always bill MVA to the patient's private insurance carrier. The automobile insurance settles with the private carrier. If an attorney is involved, get a letter from the attorney that the provider will receive reimbursement. Most automobile insurance carriers will give the money to the patient.
 

dballard2004

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I'll wager an opinion here.

I would bill each of these visits separately. I would bill the sick visit for the pneumonia to the patient's commercial insurance, and then bill the MVA to the auto insurance. It has been my experience that most commerical payers will deny claims for an MVA and will direct the provider to bill the claims to the auto insurance first. Once the auto insurance has maxed on injury benefits, then the commerical payer may reimburse. This has been my experience.

Also, when billing the MVA, I would recommend reporting the appropriate E codes and also get the claim information (i.e. claim number, adjuster's name, etc). You may also have to send in copies of the notes with each claim.

Hope this helps and again this is my opinion.
 

amarrero

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I agree with you 100%. In my over 20 years of experience, I have found your statement to be the truest.

A Marrero, CPC
 

barnetn1

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I also agree to bill both, but when doing this you must split the coding as well, you more than likely will not be billing both insurance's a 99213.
 

armen

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I have a patient that came in for neck pain related to a motor vehicle accident and was also diagnosed with pneumonia. The physician charged a 99213. Who should I bill for this service the medical insurance or the auto? Can I somehow split the charge into two seperate services to cover both problems? :confused:
in our practice we create two separate charts for this kind of situations. Two separate encounters would be created, that way we have two separate bills with two different insurances. Its easier to follow up later.
 

Michele Price

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I'll wager an opinion here.

I would bill each of these visits separately. I would bill the sick visit for the pneumonia to the patient's commercial insurance, and then bill the MVA to the auto insurance. It has been my experience that most commerical payers will deny claims for an MVA and will direct the provider to bill the claims to the auto insurance first. Once the auto insurance has maxed on injury benefits, then the commerical payer may reimburse. This has been my experience.

Also, when billing the MVA, I would recommend reporting the appropriate E codes and also get the claim information (i.e. claim number, adjuster's name, etc). You may also have to send in copies of the notes with each claim.

Hope this helps and again this is my opinion.
What if the you call the patients auto and benefits are not exhausted yet, so you bill the one MVA claim to the Auto insurance and the sick visit claim to the health insurance. When you get the MVA EOB back all the hospital charges have exhausted the benefits and your MVA claim denied. Now you cannot bill this claim as well to the health insurance because you already billed the sick visit to them. In this case (which is very common), how do you bill the health insurance for the denied MVA claim? They will deny the MVA because of the other claim you billed on the same day? Does anyone know what to do in this instance other then bill the patient?
 
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