Wiki Patient seen in office while in rehab?

[lmfort]

Patient was seen in our office for possible alzheimer's and worsening of confusion. Medicare managed care plan paid the claim. Now they have issued a refund request stating patient was in an inpatient facility at the time of service. Patient suffered a right hip fracture which was pinned then patient moved to rehab. Is there a modifier that would apply? Should we be billing the rehab even though the patient was physically brought to our office and seen for something completely separate. Please help! This is new for us.

Thank you!

 

[Pam Warren]

Patient was seen in our office for possible alzheimer's and worsening of confusion. Medicare managed care plan paid the claim. Now they have issued a refund request stating patient was in an inpatient facility at the time of service. Patient suffered a right hip fracture which was pinned then patient moved to rehab. Is there a modifier that would apply? Should we be billing the rehab even though the patient was physically brought to our office and seen for something completely separate. Please help! This is new for us.

Thank you!

When the patient is in an inpatient rehab (such as a nursing home/snf, etc). the rehab is supposed to provide all services. This happened to us when Nursing home patients were coming to our outpatient Wound Clinic, and Medicare would not pay, saying they should be receiving the services at the nursing home, and if we do them, then the nursing home has to reimburse us as part of the $$ they get to provide the overall care. We had to set up payment arrangements with our rehab centers to get reimbursed.

 

[lmfort]

Thank you Pam for your help!