Wiki well child components

[pineapplelvr]

do you bill the well child components for all insurances? we used to write them off if an insurance didn't pay for them, but now our manager wants us charge for them, which I disagree with.... I think it should only be for the medical assitance etc. (we had an audit in 2013 that said we needed to bill ALL insurances the same, but then find out which insurances didn't pay for the components and that we should write them off....we have a lot of unhappy parents getting a $150+ bill....) To me the components are part of the preventive...they shouldn't be extra....I don't want to get a bill the next time my child comes in so I'll be adamant that he does NOT need the hearing, vision and development...) just curious what others are doing? thanks


v5008 or 92551
99173
96110
s0302

 

[danskangel313]

Generally speaking, the same billing practices should be used for all payers. I'm not all that familiar with billing for EPSDT, but doesn't the charge for that service (S0302) already include the components of the screenings (hearing, vision, etc)? It's my understanding those components are required for Medicaid. If I'm correct about not reporting the components separately, you would then not be required to report them for other patients also, which would fix the problem with the write-offs, the billing equally for all patients, etc. I may be way off but I thought I'd throw that out there. If you DO have to report them separately due to a Medicaid rule, then that coding "rule" would only be applied to the MD patients, not to every patient no matter what insurance they have. It would be "Medicaid Specific" in other words. If I were to make the argument about billing every patient the same, under a circumstance so specific as this, then it would be inappropriate to bill every patient equally because the charges are REQUIRED by Medicaid rules, not all payer rules. I'd also try to get some documentation or something from other payers that say those components are NOT required, therefore there would be no reason to perform unnecessary services when they aren't required. Play the "medical necessity" card in a way. Another thought might be to offer the screenings to the parent(s) including the fact that they may not be covered; patients have the right to deny treatment, so they should be given the accurate information up front to make a well-informed decision.