E/M question

mcurry@siumed.edumcurry@siumed.edu
edited May 2017 in Part B Archive
Good Afternoon,
I have a scenario with an established patient:
the patient had vitals and a partial visit performed with MD then got upset and stated they were firing us and walked out. My question is can I bill for any of the service?

Thanks!


Mary A. Curry, CPC, CPMA


Comments

  • sandie@sccma.orgsandie@sccma.org
    edited May 2017
    Depends what extent you mean by “partial visit” but my question to you would be is it worth billing for considering the wrath you may incur from the already angry patient that wants nothing to do with you anymore…
    Sandie Moore

    Administrative Support Team
    Certified Medical Coder - Physician Advocate
    sandie@sccma.org
    408-998-8850
    sandie@sccma.org
    www.sccma-mcms.org

    “You have to be odd to be number ONE”- Dr. Seuss








  • EricaErica
    edited May 2017
    You CAN but maybe you shouldn’t. It’s probably a 99211 or 99212 depending on what was documented but is it worth it, if this already angry patient gets a bill for a co-pay or co-insurance….

  • KarenHurleyKarenHurley
    edited May 2017
    Mary:



    This will depend on what is documented and if it is countable on the E/M audit sheet.



    If there are enough countable elements, then yes – you can bill for the E/M service. If a copayment is owed, I would bill the patient as per your contract requirements. The patient will have a choice to pay or not to pay.



    Follow your usual standards for billing so your records are clear.



    The physician can also choose to forego billing for the service and consider it gratis.



    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



  • mcurry@siumed.edumcurry@siumed.edu
    edited May 2017
    Thanks everyone for the feedback. We don’t wish to upset the patient anymore, I was more interested in if we could bill these type of services.

    Mary A. Curry, CPC, CPMA
    HealthCare Compliance Officer
    Office of Compliance and Ethics
    Southern Illinois University School of Medicine
    201 E. Madison St., Suite 325
    PO Box 19683
    Springfield, Il 62794-9683
    (217) 545-6012

  • ModeratorRoyModeratorRoy
    edited May 2017
    “The physician can also choose to forego billing for the service and consider it gratis.”
    Really? I thought Medicare and other payers obliged providers to collect copays even when they don’t charge their own fee.

  • EricaErica
    edited May 2017
    Routinely waiving of co-pays/co-insurance/deductibles is fraudulent and/or a violation of insurance contracts. But cost-sharing only applies when a claim is submitted and processed by the payor. A practice may choose to make a particular service a “no charge” and not bill for it all. In that case, there is no cost to share.

  • mlewis@scrogginsgrear.commlewis@scrogginsgrear.com
    edited May 2017
    I agree with Erica- even though there was work done, it would in the best interests of the practice not to submit charges for the encounter. By not submitting the charge, there is no copayment involved.
    Maxine


    Maxine Lewis, CMM, CPC, CPC-I, CCS-P, CPMA
    Main: 513-771-7070
    Direct: 513-672-4363
    Fax: 513-326-7640
    200 Northland Blvd
    Cincinnati, OH 45246
    mlewis@scrogginsgrear.com
    www.scrogginsgrear.com

  • KarenHurleyKarenHurley
    edited May 2017
    Roy:



    This is two separate issues and is driven by the contract the provider has agreed to.



    A physician may choose to not bill for a service rendered – i.e. “no charge” and if so, the co-insurance amount would not be collected for a Medicare patient. 20% of nothing = nothing.



    As far as other plans, that is going to be by contract provision.





    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



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