RE: Medicare billing inquiry today? Send the money back! [1 Attachment]

[Guest guest]

Again you are fantastic. Thanks for the attachment of what Medicare will cover with what diagnosis. Myria

To: Sent: Tue, February 23, 2010 7:29:39 PMSubject: Re: Medicare billing inquiry today? Send the money back! [1 Attachment]

We've talked about this before -- as Kathy mentioned below -- certain codes are supposed to be covered for preventive testing and Medicare.

Although, I believe there was also a discussion recently about how Medicare (or maybe it was private insurance) didn't pay for a test that was appropriately ordered with one of the codes listed and was denied -- or at least the lab said so and billed the patient.

Anyway...see below and the attached.

On Tue, Feb 23, 2010 at 5:14 PM, Kathy Saradarian <qualityfphughes (DOT) net> wrote:

I’m not sure what V81.0 is but believe it or not, screening for cardiovascular disease is covered by Medicare to justify a lipid pane. I would search for those codes that will “cover†what you order so patient is not responsible. If it is something patient wants that you don’t think is indicated, get the ABN. By the way, preventative physicals are not covered by Medicare. Don’t know how you got paid for that.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypr actice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

[Guest guest]

The preventative services chart seems to contradict the NCD that

is currently applicable for the same service. Isn’t it interesting

how the government can’t even get their story strait in 2 different

documents that are both put out by them.

Beth Sullivan, DO

Ridgeway Family Practice

Commerce, GA 30529

From:

[mailto: ] On Behalf Of Locke

Sent: Tuesday, February 23, 2010 7:30 PM

To:

Subject: Re: Medicare billing inquiry today? Send

the money back! [1 Attachment]

[Attachment(s) from Locke included

below]

We've talked about this before -- as Kathy mentioned below

-- certain codes are supposed to be covered for preventive testing and

Medicare.

Although, I believe there was also a discussion recently

about how Medicare (or maybe it was private insurance) didn't pay for a test

that was appropriately ordered with one of the codes listed and was denied --

or at least the lab said so and billed the patient.

Anyway...see below and the attached.

I’m not

sure what V81.0 is but believe it or not, screening for cardiovascular disease

is covered by Medicare to justify a lipid pane. I would search for those

codes that will “cover” what you order so patient is not responsible.

If it is something patient wants that you don’t think is indicated, get

the ABN. By the way, preventative physicals are not covered by

Medicare. Don’t know how you got paid for that.

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing