Question My dad received a bill for a denied service - please help

Victoria323

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My mom called in to schedule a “annual exam” or maybe she used the word physical- idk, but the scheduler scheduled a service that was not covered my Medicare, and should have scheduled the wellness that is covered or at least correct them on the phone. The service was performed without ABN and my dad got billed full price for a “physical annual preventative exam”. I called billing and asked why he was billed and why a service was performed knowing it wasn’t covered and no one informed him. I think they did like blood pressure, depression and two other things. The billing department said HE scheduled it wrong, therefore he needs to pay. I don’t like to tell other hospitals I code and work in healthcare but I’m really really upset with their response and approach - and wonder what other bills are you sending elderly disabled patients and collecting their money?

How can I get this resolved for my dad? I already put in a request to quality to look over the case, but I still don’t think it’s enough to help another patients.

Any ideas/suggestions? Thank in advanced for your help!
 
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mitchellde

True Blue
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Columbia, MO
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They must have an ABN and they needed to submit the claim with the GA modifier in order to submit the bill to the patient. In addition Medicare rules for ABN indicates that every word on the ABN form be read out loud to the patient prior to the patient signing. The EOB the patient receives from Medicare should indicate if they are responsible to pay. Also request to see the ABN that was signed and attested to as being read. Remember an ABN must be specific to the service to be performed and not a blanket waiver signed at the check in desk.
 
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Petersburg, VA
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In regards to the ABN, if the service received is considered not covered per Medicare statute, the provider is not required to issue an ABN. However, it still may be issued to give the patient a heads up regarding their financial liability. As for the office, while they may not be required to further clarify the difference between an Annual Adult Preventive Exam and the Medicare specific Annual Wellness Exam, it sure seems like poor customer service.

 
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