Wiki Wellness Vist to Establish Em

[jcope1979@msn.com]

We have a patient stating that her CPE was billed by her OB/GYN earlier in the year, however she came to us for her physical. Once billed, her insurance stated that the benefit is payable only once a year and made the patient responsible for the balance. She wants us to resubmit with an established EM code. I explained to the patient this was not an option since no other diagnosis was discussed or charted. Same goes for patients who come in with issues but later want it filed as a preventative to avoid paying deds., copays etc.

Am I correct and if so, is this in writing some where I can show my provider?

 

[MISSANGIE322]

Of course you are correct! To submit any charge for payment other than the service performed and documented constitutes fraud. http://www.wpsmedicare.com/j8macpartb/departments/fraud_abuse/

 

[lgardner]

We have a patient stating that her CPE was billed by her OB/GYN earlier in the year, however she came to us for her physical. Once billed, her insurance stated that the benefit is payable only once a year and made the patient responsible for the balance. She wants us to resubmit with an established EM code. I explained to the patient this was not an option since no other diagnosis was discussed or charted. Same goes for patients who come in with issues but later want it filed as a preventative to avoid paying deds., copays etc.

Am I correct and if so, is this in writing some where I can show my provider?

yes. you are correct.

but, the patient may be able to settle this with her insurance company.
we had a lot of patients who were having this happen. but we told them to check their benefits...because if they are entitled to a preventive visit with their PCP AND entitled to a well woman visit (which most patients were) they could tell their insurance company that these were two separate benefits and should be payable.

most of our patients were able to get both visits paid for.

hope this makes sense and helps.

 

[jcp703@aol.com]

You definitely are correct. The PCP can bill the preventive exam with V70.0 as the diagnosis; the well woman exam should be billed with V72.31. We have had success with both being paid when using these. Hope it works!