Wiki Post-op visits being billed

[dollybrandie]

Looking for insite into this situation. Patient has surgery and for some reason the OR documentation is delayed by the performing surgeon and no surgical charges are billed for several weeks. In the mean time, the surgeron sees the patient on follow-up and bills a E&M level of service. The bill is processed through the system and is not "caught for global issues" due to the lack of surgical charges in the system. Normally our billing system would catch the E&M and that charge would be changed to "no bill". In this scenerio it gets paid by, let's say, Medicare prior to them receiving the surgical claim.
My question is this, has this scenerio happen to others and what was the outcome. We are attempting to be pro-active.

 

[nyyankees]

Looking for insite into this situation. Patient has surgery and for some reason the OR documentation is delayed by the performing surgeon and no surgical charges are billed for several weeks. In the mean time, the surgeron sees the patient on follow-up and bills a E&M level of service. The bill is processed through the system and is not "caught for global issues" due to the lack of surgical charges in the system. Normally our billing system would catch the E&M and that charge would be changed to "no bill". In this scenerio it gets paid by, let's say, Medicare prior to them receiving the surgical claim.
My question is this, has this scenerio happen to others and what was the outcome. We are attempting to be pro-active.

I would refund the payment E/M payments. If the doc performs the surgery he should know that this is post-op. Why is he charging an E/M? It's tough on your end but eventually the carrier will most likely ctach this is in a post-payment audit. If they see this as a 'regular' thing your doc could be in real trouble. Start with the doc as a post-op visit will alert you or the charge poster that is surgery is coming and make sure it's captured. Good luck..