Results 1 to 3 of 3

Healthcare Reform and Preventative Services

  1. #1
    Default Healthcare Reform and Preventative Services
    Medical Coding Books
    I have a patient who was seen for a Preventative Medicine 99396 which we used a diagnosis of V70.0. In addition she had preventative labs V70.0 including a Pap V72.31. Insurance was filed with her commercial plan and they responded indicating a personal responsibility due to deductible. Patient and her insurance agent insist we coded incorrectly as patient has full benefits under the healthcare reform bill. Could I get opinions on any additional coding others are using or are the above accurate and should be appealed with her plan? I'm not necessarily concerned about the misc. labs as I am the preventative medicine exam and Pap Smear.

    Any suggestions would be appreciated!

  2. #2
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by gatewayclinic View Post
    I have a patient who was seen for a Preventative Medicine 99396 which we used a diagnosis of V70.0. In addition she had preventative labs V70.0 including a Pap V72.31. Insurance was filed with her commercial plan and they responded indicating a personal responsibility due to deductible. Patient and her insurance agent insist we coded incorrectly as patient has full benefits under the healthcare reform bill. Could I get opinions on any additional coding others are using or are the above accurate and should be appealed with her plan? I'm not necessarily concerned about the misc. labs as I am the preventative medicine exam and Pap Smear.

    Any suggestions would be appreciated!
    There is a provision in the new Healthcare law that stipulates patients are not subject to deductibles or copays for preventive services. However, it does not go into effect until the plan renews, so if the patient's plan has not yet renewed for the year, it may not apply yet. Also Health plans that were already in effect on March 23, 2010 are grandfathered in and may not have to comply with the new regulations. That is expected to change in 2014. You billed correctly, the insurance company may not be subject to the new Healthcare Reform Laws...check with the payer.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  3. #3
    Default
    Very helpful. I really appreciate your response! Much thanks.

Similar Threads

  1. The Future and Healthcare Reform
    By Denise0728 in forum Employment General Discussion
    Replies: 1
    Last Post: 09-26-2014, 01:15 PM
  2. Obama care/healthcare reform
    By mieka.schambach in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 04-22-2014, 04:49 PM
  3. Preventative services
    By burnam in forum Billing/Reimbursement
    Replies: 2
    Last Post: 05-19-2011, 07:16 AM
  4. New healthcare reform bill
    By HBULLOCK in forum Pediatrics
    Replies: 0
    Last Post: 01-06-2011, 08:16 AM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.