Loading ...
Sorry, an error occurred while loading the content.

Entering Referring Physician Info

Expand Messages
  • nicole mezni
    Hello everyone, I have a new pt consult to bill (99243), and the person who referred the pt was someone from his place of worship. How do I document that on
    Message 1 of 5 , Jul 2, 2008
    • 0 Attachment
      Hello everyone,

      I have a new pt consult to bill (99243), and the person who referred the pt was someone from his place of worship.

      How do I document that on the claim, if a physician did not refer them? I obviously don't have an NPI to enter or anything?

      Thanks!!!

      Nicole Mezni



      [Non-text portions of this message have been removed]
    • B Burgess
      In that case, it is NOT a consult, and not a 99243.  If the patient was not sent by a medical provider who was requesting an opinion or advice regarding the
      Message 2 of 5 , Jul 2, 2008
      • 0 Attachment
        In that case, it is NOT a consult, and not a 99243.  If the patient was not sent by a medical provider who was requesting an opinion or advice regarding the patient AND no communication was sent back to the provider who requested the "consult" giving the consultant's opinion and/or advice, then your patient is merely a New Patient and the service should be billed from the 99201-99205 series of codes.
         
        Barbara Burgess, RN, CPC, ACS-EM, PCS
        University of South Alabama
        Coding & Compliance Nurse Specialist

        --- On Wed, 7/2/08, nicole mezni <nmezni@...> wrote:

        From: nicole mezni <nmezni@...>
        Subject: [MedicalBillers] Entering Referring Physician Info
        To: MedicalBillers@yahoogroups.com
        Date: Wednesday, July 2, 2008, 8:59 PM






        Hello everyone,

        I have a new pt consult to bill (99243), and the person who referred the pt was someone from his place of worship.

        How do I document that on the claim, if a physician did not refer them? I obviously don't have an NPI to enter or anything?

        Thanks!!!

        Nicole Mezni

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


















        [Non-text portions of this message have been removed]
      • nicole mezni
        Thank you so much, Barbara!!!!!!! Nicole Mezni ... From: B Burgess To: MedicalBillers@yahoogroups.com Sent: Wednesday, July 02, 2008 11:07 PM Subject: Re:
        Message 3 of 5 , Jul 2, 2008
        • 0 Attachment
          Thank you so much, Barbara!!!!!!!

          Nicole Mezni

          ----- Original Message -----
          From: B Burgess
          To: MedicalBillers@yahoogroups.com
          Sent: Wednesday, July 02, 2008 11:07 PM
          Subject: Re: [MedicalBillers] Entering Referring Physician Info


          In that case, it is NOT a consult, and not a 99243. If the patient was not sent by a medical provider who was requesting an opinion or advice regarding the patient AND no communication was sent back to the provider who requested the "consult" giving the consultant's opinion and/or advice, then your patient is merely a New Patient and the service should be billed from the 99201-99205 series of codes.

          Barbara Burgess, RN, CPC, ACS-EM, PCS
          University of South Alabama
          Coding & Compliance Nurse Specialist

          --- On Wed, 7/2/08, nicole mezni <nmezni@...> wrote:

          From: nicole mezni <nmezni@...>
          Subject: [MedicalBillers] Entering Referring Physician Info
          To: MedicalBillers@yahoogroups.com
          Date: Wednesday, July 2, 2008, 8:59 PM

          Hello everyone,

          I have a new pt consult to bill (99243), and the person who referred the pt was someone from his place of worship.

          How do I document that on the claim, if a physician did not refer them? I obviously don't have an NPI to enter or anything?

          Thanks!!!

          Nicole Mezni

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

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





          [Non-text portions of this message have been removed]
        • B Burgess
          Anytime !!  We go round and round with our docs all the time (especially the specialists who think they are, well, SPECIAL !) about the difference between a
          Message 4 of 5 , Jul 2, 2008
          • 0 Attachment
            Anytime !!  We go round and round with our docs all the time (especially the specialists who think they are, well, SPECIAL !) about the difference between a consult and a referral, and that even if it IS intended to be a consult that if there is no communication back to the requesting provider that the consult criteria has not been met and it is not billable as a consult.  And, just because there is a "referring" physician, that still doesn't automatically make it a consult !
             
            My husband recently saw a GI doc only because I have bugged him for 3 years about getting a screening colonoscopy based only on the fact that he is over 50.  He picked one out of the phone book and made an appt.  I got the insurance EOB and had a fit............ the visit was billed as a 99245 - a HIGH level consult.  NO chief compliant, no problems, no nothing. Very little in the way of exam, no labs, xrays, prescriptions, etc.  Just scheduled him for the procedure.  And, to make matters worse, he saw that nurse practitioner, but the service was billed in the docs name (we have BCBS).   It was enough to make me call and request that they refund the $$ to my insurance company for the services that were billed AND NOT PROVIDED.  I was nice about it, but insistant. The office manager's explanation was that my husband's primary care doc was noted on the chart.  His primary care didn't even have a clue that he was going to a GI doc !!  They just
            happened to ask him who his regular doctor was, so he answered their question !   I was told that they would refund and rebill; We'll see what happens...................
             
            Barbara

            --- On Wed, 7/2/08, nicole mezni <nmezni@...> wrote:

            From: nicole mezni <nmezni@...>
            Subject: Re: [MedicalBillers] Entering Referring Physician Info
            To: MedicalBillers@yahoogroups.com
            Date: Wednesday, July 2, 2008, 10:14 PM






            Thank you so much, Barbara!!!!! !!

            Nicole Mezni

            ----- Original Message -----
            From: B Burgess
            To: MedicalBillers@ yahoogroups. com
            Sent: Wednesday, July 02, 2008 11:07 PM
            Subject: Re: [MedicalBillers] Entering Referring Physician Info

            In that case, it is NOT a consult, and not a 99243. If the patient was not sent by a medical provider who was requesting an opinion or advice regarding the patient AND no communication was sent back to the provider who requested the "consult" giving the consultant's opinion and/or advice, then your patient is merely a New Patient and the service should be billed from the 99201-99205 series of codes.

            Barbara Burgess, RN, CPC, ACS-EM, PCS
            University of South Alabama
            Coding & Compliance Nurse Specialist

            --- On Wed, 7/2/08, nicole mezni <nmezni@.... com> wrote:

            From: nicole mezni <nmezni@.... com>
            Subject: [MedicalBillers] Entering Referring Physician Info
            To: MedicalBillers@ yahoogroups. com
            Date: Wednesday, July 2, 2008, 8:59 PM

            Hello everyone,

            I have a new pt consult to bill (99243), and the person who referred the pt was someone from his place of worship.

            How do I document that on the claim, if a physician did not refer them? I obviously don't have an NPI to enter or anything?

            Thanks!!!

            Nicole Mezni

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

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

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


















            [Non-text portions of this message have been removed]
          • Weis, LuAnn
            Barbara, That happened to me also. Meanwhile, the GI doc knew that I work for the compliance dept. @ the hospital where he was performing my colonoscopy. I
            Message 5 of 5 , Jul 3, 2008
            • 0 Attachment
              Barbara,

              That happened to me also. Meanwhile, the GI doc knew that I work for the
              compliance dept. @ the hospital where he was performing my colonoscopy.
              I educated him just as I would if he was on our faculty practice staff!!
              The money went right back to the hospital's self-insured manage care
              company!



              LuAnn Weis, MPA
              Compliance Specialist


              -----Original Message-----
              From: MedicalBillers@yahoogroups.com
              [mailto:MedicalBillers@yahoogroups.com] On Behalf Of B Burgess
              Sent: Wednesday, July 02, 2008 11:35 PM
              To: MedicalBillers@yahoogroups.com
              Subject: Re: [MedicalBillers] Entering Referring Physician Info



              Anytime !! We go round and round with our docs all the time (especially
              the specialists who think they are, well, SPECIAL !) about the
              difference between a consult and a referral, and that even if it IS
              intended to be a consult that if there is no communication back to the
              requesting provider that the consult criteria has not been met and it is
              not billable as a consult. And, just because there is a "referring"
              physician, that still doesn't automatically make it a consult !

              My husband recently saw a GI doc only because I have bugged him for 3
              years about getting a screening colonoscopy based only on the fact that
              he is over 50. He picked one out of the phone book and made an appt. I
              got the insurance EOB and had a fit............ the visit was billed as
              a 99245 - a HIGH level consult. NO chief compliant, no problems, no
              nothing. Very little in the way of exam, no labs, xrays, prescriptions,
              etc. Just scheduled him for the procedure. And, to make matters worse,
              he saw that nurse practitioner, but the service was billed in the docs
              name (we have BCBS). It was enough to make me call and request that
              they refund the $$ to my insurance company for the services that were
              billed AND NOT PROVIDED. I was nice about it, but insistant. The office
              manager's explanation was that my husband's primary care doc was noted
              on the chart. His primary care didn't even have a clue that he was
              going to a GI doc !! They just
              happened to ask him who his regular doctor was, so he answered their
              question ! I was told that they would refund and rebill; We'll see
              what happens...................

              Barbara

              --- On Wed, 7/2/08, nicole mezni <nmezni@...
              <mailto:nmezni%40cfl.rr.com> > wrote:

              From: nicole mezni <nmezni@... <mailto:nmezni%40cfl.rr.com> >
              Subject: Re: [MedicalBillers] Entering Referring Physician Info
              To: MedicalBillers@yahoogroups.com
              <mailto:MedicalBillers%40yahoogroups.com>
              Date: Wednesday, July 2, 2008, 10:14 PM

              Thank you so much, Barbara!!!!! !!

              Nicole Mezni

              ----- Original Message -----
              From: B Burgess
              To: MedicalBillers@ yahoogroups. com
              Sent: Wednesday, July 02, 2008 11:07 PM
              Subject: Re: [MedicalBillers] Entering Referring Physician Info

              In that case, it is NOT a consult, and not a 99243. If the patient was
              not sent by a medical provider who was requesting an opinion or advice
              regarding the patient AND no communication was sent back to the provider
              who requested the "consult" giving the consultant's opinion and/or
              advice, then your patient is merely a New Patient and the service should
              be billed from the 99201-99205 series of codes.

              Barbara Burgess, RN, CPC, ACS-EM, PCS
              University of South Alabama
              Coding & Compliance Nurse Specialist

              --- On Wed, 7/2/08, nicole mezni <nmezni@... <mailto:nmezni%40cfl.rr>
              . com> wrote:

              From: nicole mezni <nmezni@... <mailto:nmezni%40cfl.rr> . com>
              Subject: [MedicalBillers] Entering Referring Physician Info
              To: MedicalBillers@ yahoogroups. com
              Date: Wednesday, July 2, 2008, 8:59 PM

              Hello everyone,

              I have a new pt consult to bill (99243), and the person who referred the
              pt was someone from his place of worship.

              How do I document that on the claim, if a physician did not refer them?
              I obviously don't have an NPI to enter or anything?

              Thanks!!!

              Nicole Mezni

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

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

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

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




              *** HUMC's Proactive Security and Virus Scanner has scanned this email
              for
              malicious content and it is safe to use***

              **************************************************************************************************

              [Non-text portions of this message have been removed]
            Your message has been successfully submitted and would be delivered to recipients shortly.