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Preventive Care Visits to Patients

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  • Mary I. Falbo, MBA, CPC
    Hi Everyone, Does anyone have any experience with the following? A patient ( NOT MEDICARE) does not have preventive care coverage with their insurance plan.
    Message 1 of 8 , Mar 1, 2001
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      Hi Everyone,
      Does anyone have any experience with the following?
      A patient ( NOT MEDICARE) does not have preventive care coverage with their insurance plan. If a physician does a preventive and a sick visit, can he apply the same rules to this patient as with Medicare patients? (e.go. Deduct the sick portion from the Preventive Charge and have the patient pay the difference?)

      Is there anything in writing that talks about this?
      Thanks,
      mare


      [Non-text portions of this message have been removed]
    • Betsy Nicoletti
      Hi Mare, I don t have anything in writing about this. One OB/GYN doctor that I work with has billed some commercial insurances for both the preventive medicine
      Message 2 of 8 , Mar 1, 2001
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        Hi Mare,
        I don't have anything in writing about this.

        One OB/GYN doctor that I work with has billed some commercial insurances
        for both the preventive medicine visit and the sick visit, putting a 25
        modifier on the sick visit, when the pt had a medical problem that was
        addressed at the time of the PM visit. We don't subtract the value--we
        bill them both. Some commercials pay them both, some pay only the sick
        visit.

        Since we're following CPT rules--billing out only services we provided,
        with appropriate dx codes-- and using the modifier appropriately, I think
        we're doing the right thing.
        Betsy

        -----Original Message-----
        From: Mary I. Falbo, MBA, CPC [SMTP:mfalbo@...]
        Sent: Thursday, March 01, 2001 8:08 AM
        To: CRN-L@yahoogroups.com
        Subject: [CRN-L] Preventive Care Visits to Patients

        Hi Everyone,
        Does anyone have any experience with the following?
        A patient ( NOT MEDICARE) does not have preventive care coverage with
        their insurance plan. If a physician does a preventive and a sick visit,
        can he apply the same rules to this patient as with Medicare patients?
        (e.go. Deduct the sick portion from the Preventive Charge and have the
        patient pay the difference?)

        Is there anything in writing that talks about this?
        Thanks,
        mare


        [Non-text portions of this message have been removed]


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      • whooks3335@aol.com
        It makes sense to do that but you need to review your contract first though I suspect it would be silent about this issue.
        Message 3 of 8 , Mar 1, 2001
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          It makes sense to do that but you need to review your contract first though I
          suspect it would be silent about this issue.
        • Dianne Wilkinson
          The guidance in the CPT does not say either way about subtracting, as we do with Medicare; but to be on solid ground all the way, it would probably be best to
          Message 4 of 8 , Mar 1, 2001
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            The guidance in the CPT does not say either way about subtracting, as we do
            with Medicare; but to be on solid ground all the way, it would probably be
            best to check with your various health plans on this, then write up as a
            policy. Just a thought...Dianne.

            -----Original Message-----
            From: Mary I. Falbo, MBA, CPC [mailto:mfalbo@...]
            Sent: Thursday, March 01, 2001 7:08 AM
            To: CRN-L@yahoogroups.com
            Subject: [CRN-L] Preventive Care Visits to Patients


            Hi Everyone,
            Does anyone have any experience with the following?
            A patient ( NOT MEDICARE) does not have preventive care coverage with their
            insurance plan. If a physician does a preventive and a sick visit, can he
            apply the same rules to this patient as with Medicare patients? (e.go.
            Deduct the sick portion from the Preventive Charge and have the patient pay
            the difference?)

            Is there anything in writing that talks about this?
            Thanks,
            mare


            [Non-text portions of this message have been removed]


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          • HPMSInc@aol.com
            Sure he could - but why? How about billing for both services, since both were done? The patient should pay for the PM service if it is performed, and the
            Message 5 of 8 , Mar 2, 2001
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              Sure he could - but why? How about billing for both services, since both
              were done?

              The patient should pay for the PM service if it is performed, and the
              insurance should pay/consider the sick visit if they have coverage for it.

              Karen Hurley

              In a message dated 3/1/01 7:57:57 AM Eastern Standard Time, mfalbo@...
              writes:


              > Hi Everyone,
              > Does anyone have any experience with the following?
              > A patient ( NOT MEDICARE) does not have preventive care coverage with
              > their insurance plan. If a physician does a preventive and a sick visit,
              > can he apply the same rules to this patient as with Medicare patients?
              > (e.go. Deduct the sick portion from the Preventive Charge and have the
              > patient pay the difference?)
              >
              > Is there anything in writing that talks about this?
              > Thanks,
              > mare
              >




              [Non-text portions of this message have been removed]
            • Donna Gryder
              I would check your contracts with the carriers. We have some carriers who will apply a copay to each service - try explaining that one to the patient. Others
              Message 6 of 8 , Mar 2, 2001
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                I would check your contracts with the carriers. We have some carriers who
                will apply a copay to each service - try explaining that one to the patient.
                Others are bundling the 2 EMs together and reimbursing on one. Then there
                are the ones that will request records because they don't have preventive
                care coverage and don't want to pay if they don't have to. As for obtaining
                the rules in writing - good luck, we have enought problems getting the
                commerical carriers to understand the concept much less put in writing.

                Donna Gryder
                ----- Original Message -----
                From: <HPMSInc@...>
                To: <CRN-L@yahoogroups.com>
                Sent: Friday, March 02, 2001 7:55 AM
                Subject: Re: [CRN-L] Preventive Care Visits to Patients


                > Sure he could - but why? How about billing for both services, since both
                > were done?
                >
                > The patient should pay for the PM service if it is performed, and the
                > insurance should pay/consider the sick visit if they have coverage for it.
                >
                > Karen Hurley
                >
                > In a message dated 3/1/01 7:57:57 AM Eastern Standard Time,
                mfalbo@...
                > writes:
                >
                >
                > > Hi Everyone,
                > > Does anyone have any experience with the following?
                > > A patient ( NOT MEDICARE) does not have preventive care coverage with
                > > their insurance plan. If a physician does a preventive and a sick
                visit,
                > > can he apply the same rules to this patient as with Medicare patients?
                > > (e.go. Deduct the sick portion from the Preventive Charge and have the
                > > patient pay the difference?)
                > >
                > > Is there anything in writing that talks about this?
                > > Thanks,
                > > mare
                > >
                >
                >
                >
                >
                > [Non-text portions of this message have been removed]
                >
                >
                > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                > Homepage: www.codingandreimbursement.net
                > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                > Show your appreciation and support of the CRN visit this page to see how!
                www.codingandreimbursement.net/support.htm
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                mailto:CRN-L-unsubscribe@yahoogroups.com.
                > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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                > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                >
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                >
                >
              • Mary I. Falbo, MBA, CPC
                For patient relations reasons, he wants to exercise the option of giving the patient a break. As long as he is not doing anything illegal from a compliance
                Message 7 of 8 , Mar 3, 2001
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                  For patient relations reasons, he wants to exercise the option of giving the
                  patient a break. As long as he is not doing anything illegal from a
                  compliance standpoint, he would like to proceed.
                  Thanks,
                  Mare
                  ----- Original Message -----
                  From: <HPMSInc@...>
                  To: <CRN-L@yahoogroups.com>
                  Sent: Friday, March 02, 2001 7:55 AM
                  Subject: Re: [CRN-L] Preventive Care Visits to Patients


                  > Sure he could - but why? How about billing for both services, since both
                  > were done?
                  >
                  > The patient should pay for the PM service if it is performed, and the
                  > insurance should pay/consider the sick visit if they have coverage for it.
                  >
                  > Karen Hurley
                  >
                  > In a message dated 3/1/01 7:57:57 AM Eastern Standard Time,
                  mfalbo@...
                  > writes:
                  >
                  >
                  > > Hi Everyone,
                  > > Does anyone have any experience with the following?
                  > > A patient ( NOT MEDICARE) does not have preventive care coverage with
                  > > their insurance plan. If a physician does a preventive and a sick
                  visit,
                  > > can he apply the same rules to this patient as with Medicare patients?
                  > > (e.go. Deduct the sick portion from the Preventive Charge and have the
                  > > patient pay the difference?)
                  > >
                  > > Is there anything in writing that talks about this?
                  > > Thanks,
                  > > mare
                  > >
                  >
                  >
                  >
                  >
                  > [Non-text portions of this message have been removed]
                  >
                  >
                  > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                  > Homepage: www.codingandreimbursement.net
                  > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                  > Show your appreciation and support of the CRN visit this page to see how!
                  www.codingandreimbursement.net/support.htm
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                  > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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                  >
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                  >
                  >
                • Fred Wolfe
                  I don t see where this is a compliance issue; it s simply office policy regarding fees. If you wish to apply a Medicare rule for a commercial/private pay
                  Message 8 of 8 , Mar 3, 2001
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                    I don't see where this is a compliance issue; it's simply
                    office policy regarding fees. If you wish to apply
                    a Medicare rule for a commercial/private pay sick/pm visit
                    then do so. I don't see how this could ever be a problem.
                    Although CPT indicates you should charge for both it does
                    not, of course, provide guidance regarding how much to charge.

                    Fred Wolfe
                    mailto:fwolfe@...
                    Phone 304.697.5700
                    Fax 304.697.5704

                    ----- Original Message -----
                    From: Mary I. Falbo, MBA, CPC <mfalbo@...>
                    To: <CRN-L@yahoogroups.com>
                    Sent: Saturday, March 03, 2001 10:07 AM
                    Subject: Re: [CRN-L] Preventive Care Visits to Patients


                    > For patient relations reasons, he wants to exercise the option of giving
                    the
                    > patient a break. As long as he is not doing anything illegal from a
                    > compliance standpoint, he would like to proceed.
                    > Thanks,
                    > Mare
                    > ----- Original Message -----
                    > From: <HPMSInc@...>
                    > To: <CRN-L@yahoogroups.com>
                    > Sent: Friday, March 02, 2001 7:55 AM
                    > Subject: Re: [CRN-L] Preventive Care Visits to Patients
                    >
                    >
                    > > Sure he could - but why? How about billing for both services, since
                    both
                    > > were done?
                    > >
                    > > The patient should pay for the PM service if it is performed, and the
                    > > insurance should pay/consider the sick visit if they have coverage for
                    it.
                    > >
                    > > Karen Hurley
                    > >
                    > > In a message dated 3/1/01 7:57:57 AM Eastern Standard Time,
                    > mfalbo@...
                    > > writes:
                    > >
                    > >
                    > > > Hi Everyone,
                    > > > Does anyone have any experience with the following?
                    > > > A patient ( NOT MEDICARE) does not have preventive care coverage with
                    > > > their insurance plan. If a physician does a preventive and a sick
                    > visit,
                    > > > can he apply the same rules to this patient as with Medicare patients?
                    > > > (e.go. Deduct the sick portion from the Preventive Charge and have the
                    > > > patient pay the difference?)
                    > > >
                    > > > Is there anything in writing that talks about this?
                    > > > Thanks,
                    > > > mare
                    > > >
                    > >
                    > >
                    > >
                    > >
                    > > [Non-text portions of this message have been removed]
                    > >
                    > >
                    > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                    > > Homepage: www.codingandreimbursement.net
                    > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                    > > Show your appreciation and support of the CRN visit this page to see
                    how!
                    > www.codingandreimbursement.net/support.htm
                    > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                    > > To change your subscription settings (i.e.. digest or vacation mode) go
                    to
                    > http://groups.yahoo.com/mygroups?edit=1. To unsubscribe send an e-mail to
                    > mailto:CRN-L-unsubscribe@yahoogroups.com.
                    > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                    > > For advertiser options visit this page
                    > www.codingandreimbursement.net/Advertising.htm.
                    > > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                    > >
                    > > Your use of Yahoo! Groups is subject to
                    http://docs.yahoo.com/info/terms/
                    > >
                    > >
                    >
                    >
                    > ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
                    > Homepage: www.codingandreimbursement.net
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                    >
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                    >
                    >
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