Diane P
New
Effective January 2010, Medicare no longer reimburses for consultation services/codes and instructs providers to continue to document the request, the reason, and to render an opinion for the encounter. Medicare patients are then billed 99201-99215 for outpatient consultation services. CMS further states that any service that is intended for the purpose of rendering an opinion cannot be a shared service. So even though consultation codes are not being rendered/billed, essentially an opinion is being rendered and therefore these resulting 99201-99215 cannot be a shared service. (Doesn't make sense to me.)
I would like to inquire with other facilities how they are handling these. In order to accommodate patients in a timely manner, many organizations have acquired APPs to assist with patient demand. Most times, a provider participates in the management of care of this patient, i.e, as in a shared service, knowing that the requesting provider (PCP etc.) is expecting to have an opinion of a physician, not necessarily an APP.
With that being said, how are others billing for this? Are my fellow AAPC friends billing under the APP, even though technically shared services are being performed because the physician is participating in the care resulting in reimbursement of 85% of the fee schedule? Or are my fellow AAPC friends only scheduling consultations with physicians, rather than APPs in order to maximum reimbursement at 100%. Potentially delaying these visits, and potentially delaying care, so the patient can see the provider somehow doesn't seem like quality care for our patients. I think consultations should be reconsidered to be included in split/shared services.
Very interested in knowing how others are handling this situation.
Many thanks in advance,
I would like to inquire with other facilities how they are handling these. In order to accommodate patients in a timely manner, many organizations have acquired APPs to assist with patient demand. Most times, a provider participates in the management of care of this patient, i.e, as in a shared service, knowing that the requesting provider (PCP etc.) is expecting to have an opinion of a physician, not necessarily an APP.
With that being said, how are others billing for this? Are my fellow AAPC friends billing under the APP, even though technically shared services are being performed because the physician is participating in the care resulting in reimbursement of 85% of the fee schedule? Or are my fellow AAPC friends only scheduling consultations with physicians, rather than APPs in order to maximum reimbursement at 100%. Potentially delaying these visits, and potentially delaying care, so the patient can see the provider somehow doesn't seem like quality care for our patients. I think consultations should be reconsidered to be included in split/shared services.
Very interested in knowing how others are handling this situation.
Many thanks in advance,
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