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Cash Pay Only...Is this legal?

  1. #1
    Default Cash Pay Only...Is this legal?
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    We have a Medicare patient that is participating in our Wellness “Self Pay” Physical, and also needs a Pre-Op Clearance on the same date of service. He would like us to discount his Wellness Exam (that we do not submit to Medicare..cash pay only service) the amount that is paid on his Pre Op Clearance. This is a first time for such a request. Is this LEGAL...?

  2. #2
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    You can carve out a problem visit from a well care visit. I have never heard of carving out a what is essentially a well care visit in the form of a pre-op from another well care visit.

    This does not sound right to me at all. I would probably advise the provider to play it safe and just do the pre-op and have the patient return at a later date for the well care exam.

    Just my opinion,

    Laura, CPC, CEMC

  3. #3
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    Quote Originally Posted by Partha View Post
    We have a Medicare patient that is participating in our Wellness “Self Pay” Physical, and also needs a Pre-Op Clearance on the same date of service. He would like us to discount his Wellness Exam (that we do not submit to Medicare..cash pay only service) the amount that is paid on his Pre Op Clearance. This is a first time for such a request. Is this LEGAL...?
    Here's my thought....If the patient needs pre-op clearance due to underlying conditions (HTN, DM, etc), this is, in itelf, a problem oriented visit. I'm assuming that this is why the pre-op exam is needed...for clearance due to some chronic conditions. Chpt 12 of the Medicare manual states...

    "Preoperative consultations are payable for new or established patients performed by any physician or qualified NPP at the request of a surgeon, as long as all of the requirements for performing and reporting the consultation codes are met and the service is medically necessary and not routine screening."

    Therefore, this could be subtracted out just like any other problem oriented visit on the same day as a wellness.

    Partha, this was a really good question...I had to chew on this for a couple of minutes. The more I thought about it, the more it made sense. We all have our "go to" folks for that "seal the deal" and I did seek their opinion. They carry the same view.

    Just my two cents...

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