Wiki Screening colonoscopy covered 100% by Medicare

[coderfromtexas]

Screening colonoscopies are covered 100% by Medicare. Yet on our claims, they are only waiving the coinsurance only on the lines that are the actual colonoscopy or anesthesia. They are assigning coinsurance on all other lines, supplies, medications, recovery etc. There isn't much that is patient responsibility, but we do have a patient questioning why they are getting a bill for any amount. We are a CAH, so I am wondering if Medicare is reimbursing incorrectly. Can anyone else weigh in on how they are getting paid and if this sounds correct? Thank you!

 

[LisaAlonso23]

Screening colonoscopies are covered 100% by Medicare. Yet on our claims, they are only waiving the coinsurance only on the lines that are the actual colonoscopy or anesthesia. They are assigning coinsurance on all other lines, supplies, medications, recovery etc. There isn't much that is patient responsibility, but we do have a patient questioning why they are getting a bill for any amount. We are a CAH, so I am wondering if Medicare is reimbursing incorrectly. Can anyone else weigh in on how they are getting paid and if this sounds correct? Thank you!

I would start by looking at the coding to see if it's correct.

 

[coderfromtexas]

Thank you for the reply. Coding is correct. When I compare EOBs, the diagnostic colonoscopy lines apply a co-insurance, these screening lines do not. But all the other lines on the claim apply a co-insurance. Any other CAHs have this same experience?