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Consult 2010 Non-Medicare

  1. #11
    Location
    Kansas City, MO
    Posts
    751
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    Medical Coding Books
    Quote Originally Posted by swhitus View Post
    Angela,
    Could you tell me where you found the information on the advantage plans? I've looked at the carrier websites and must be looking over it. It would certainly help if you could be more specific.

    Thanks so much!
    S. Whitus, CPC, CPMA
    Here is the link for the UHC, it is on the home page and you don't even need to log-in to access it. https://www.unitedhealthcareonline.c...ode_Update.pdf

    The last two paragraphs are the ones related to Medicare and Medicaid products.

    The Humana link has apparently been moved. We did receive a table from the Kansas Medical Society, as they used their contacts with each of the insurance companies to compile a list for their members. It also states that Humana Medicare Advantage plans are following CMS.
    Angela Jordan, CPC, COBGC, AAPC Fellow
    Senior Managing Consultant
    Medical Revenue Solutions, LLC
    AAPC National Advisory Board - Southwest
    AAPCCA BOD Chair 2012-2013
    angela@medicalrevenuesolutions.com

  2. #12
    Location
    Sioux Falls South Dakota
    Posts
    358
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    All of the MADV plans we contacted state they are following Medicare guidelines, so we are not filing consult codes to them.

    Also, per our MAC, we can convert from consult to the other codes when Medicare is secondary. Luckily, our computer billing program allowed us to create key codes that change the code when filing the secondary electronically, so we don't need to do it manually.

  3. #13
    Location
    Columbia, MO
    Posts
    12,843
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    The problem I have with that is that there i no cross over between the old consult codes and the codes we are to now use in their place. They do not translate like that so what are the odds that you will be billing for visit levels that documentation does not support.

    Debra A. Mitchell, MSPH, CPC-H

  4. #14
    Default
    I was on the medicare teleconference they had concerning the new codes and they stated if you bill the primary the consultations code and then when billing medicare secondary-CHANGE the codes, as long as they have the billing amount and an EOB showing you billed a consult code, they will pay it if the patient has the coverage

  5. #15
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    Quote Originally Posted by herrera4 View Post
    I was on the medicare teleconference they had concerning the new codes and they stated if you bill the primary the consultations code and then when billing medicare secondary-CHANGE the codes, as long as they have the billing amount and an EOB showing you billed a consult code, they will pay it if the patient has the coverage
    My software will not allow the code to be changed before sending to the secondary. What should I do, just write off the balance?
    Walker Bachman, CPC, CPPM

  6. #16
    Location
    Dover Seacoast New Hampshire
    Posts
    2,016
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    Quote Originally Posted by mitchellde View Post
    The problem I have with that is that there i no cross over between the old consult codes and the codes we are to now use in their place. They do not translate like that so what are the odds that you will be billing for visit levels that documentation does not support.
    There are crosswalks in place, you can create your own by matching up the documentation guidelines and key components. For MSP, you will have to audit your documentation and consider place of service as well as status of patient (new, established). I'd be happy to email you our crosswalk, but the E&M guidelines from your local carrier should have published them by now.

    If you decide to bill the consultation codes to your commercial payers, you will have to re-code the documentation for secondary submission to Medicare, because you may not write off the difference, nor submit a consult code to Medicare. They are aware the codes and EOB from primary won't match. If you code the E&M codes for both payers, you're going to lose revenue from your commercial payers. You have to base this decision on your Medicare volume. We did a cost analysis; specialists will take a hit, but the primary care docs and hospitalists will make out.

    Pam Brooks, PCS, CPC
    Physician Services Coding Supervisor
    Wentworth-Douglass Hospital
    Dover, NH 03820

  7. #17
    Location
    Dover Seacoast New Hampshire
    Posts
    2,016
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    Quote Originally Posted by mitchellde View Post
    My understanding is you will not be allowed to convert to non-consult codes once it has been submitted to the primary.
    I believe that is incorrect. Check MedLearn Matters article MM6740. It specifically instructs you to do so. As long as you bill appropriately to your primary payer (per your contract), and don't take any additional adjustments or writeoffs, you can re-code the visit to submit to MSP.

    Pam Brooks, PCS, CPC
    Physician Services Coding Supervisor
    Wentworth-Douglass Hospital
    789 Central Avenue
    Dover, NH 03820

  8. #18
    Location
    Dover Seacoast New Hampshire
    Posts
    2,016
    Default
    Quote Originally Posted by Walker22 View Post
    My software will not allow the code to be changed before sending to the secondary. What should I do, just write off the balance?

    According to the Medicare Fraud and abuse guidelines, you may not create any financial adjustments based on the patients Medicare beneficiary status. This means you may not adjust the co-insurance balance rather than re-code and re-submit because Medicare doesn't accept the code billed to the primary. No matter what you have to come up with to workaround in your system, you cannot write off the Medicare co-insurance.

    Pam Brooks, PCS, CPC
    Physician Services Coding Supervisor
    Wentworth-Douglass Hospital
    Dover, NH 03820

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