Wiki Sent to ER after RE eval for swollen wrist

dtricia

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Patient seen previously for swollen wrist. returns and reevaluted by a different provider who does a thorough exam and consults with ortho, decides he should go to ER, possible sepsis. Should this be billed to patient?
Patient disputes .
Tricia
 
I do not see the reasoning as to why the patient would be financially responsible for this, unless he of course has no insurance. If you are meaning to say that the patient was seen by 2 different providers on the same DOS, the pt still would not be responsible for the 2nd visit, minus any ded/copay.
 
if the providers are 2 different specialties, say one internal med and one ortho, they bill under 2 separate NPI's and they are 2 different specialties, so they each would submit a claim.
 
Both providers belong to the same Immediate Care Group. The visits are 4 days apart. The patient was instructed at visit one to return if he did not improve after taking Zpak. Still sore and swollen, he presents for follow-up. I am inclined to agree that the 2nd visit should not be billed. But provider one says it is cellulitis froma spider bite, provider two says septic arthritis of his wrist. He is now being sent to ER. He has insurance.
Tricia
 
There is no rationale to charge the visit to the patient. The patient did as instructed by the provider. You have two physicians that had different diagnosis rendered 4 days apart. The second encounter I can only assume the physician deemed the condition to be beyond what could be treated in your office and sent the patient to the ER for immediate treatment. None of these encounters are patient responsibility unless the insurance instructs due to deductible or other issues with the particular plan.
 
Thank you, ladies. I did not think this should be billed either. The patient was following the instruction to return to the clinic. He got no relief and this is just a continuation.
Tricia D
 
you are welcome!! My question now is this: "who" feels that this patient was responsible for the 2nd appt? The doctor? The office manager? I would suggest additional education because of the legalities involved potentially.

Let me/us know if you have more questions and have a great day!
 
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