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Consults and commercial carriers

  1. #1
    Question Consults and commercial carriers
    Medical Coding Books
    Today has been a blue cross blue shield nightmare day. I have had 3 outpatient consults come back to me from them stating they will cover a new patient visit but not a consult.

    These really are consults. All the requirements are met. I am at a loss. The patients of course want us to rebill, but how can we when it is correct as is?

    Is anyone aware of commercial carriers stopping payment on consults already? I figure they will if CMS does but that hasn't happened yet. These are not HMO plans, just straight BC/BS of Michigan.

    Thanks

    Laura, CPC, CEMC

  2. Default
    This is a link to a website for Colorado Medical Society and this was part of a newsletter that they posted for Colorado Physicians, but it is a compliance issue for many Blue Cross plans. Hope this helps.

    http://www.cms.org/enews/Jun09/PAISettlement.pdf

  3. #3
    Default Very interesting...
    I hadn't seen this before, but I have never really had an issue with BC/BS until today. At least not one I was aware of.

    Thanks

    Laura, CPC, CEMC

  4. Default
    I just left employment of a major insurance carrier (and came back to the physician side) and I can tell you that it is my belief that this will become an even bigger issue in the future. BCBS has been sued and Humana has been sued, both of them with settlements that required that they honor CPT guidelines. Who would have thought that it even had to be said to do so. Good luck.

    Wendi, CPC

  5. #5
    Location
    Milwaukee WI
    Posts
    4,466
    Default Link doesn't work
    I cannot get the link to work. Could there be a typo somewhere?

    F Tessa Bartels, CPC, CEMC

  6. #6
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    no typo Tessa . it works for me... it's a one page notice..
    Donna, CPC, CPC-H

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