Re: Auto Insurance Billing

[Guest guest]

At the " big groups " I worked in before, it was done that way.  Worker's Comp records had to be kept in second chart and the new patient charge is presumably for setting that up.  I can't guantee that this was reviewed with legal and/or billing experts, but they tended to on decisions like that.  I haven't been doing it in my IMP; never thought about it until you raised the issue.

Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax:  www.SharonMD.com

 

I'm helping my mom go through her reams of medical bills from the past year and a half.  She was rear-ended in her car in January, 2010.  She saw her PCP 2-3 days after the accident when she wasn't starting to feel better.  She just got a bill (we don't know why the auto insurance has not yet paid other than we are still contending that we are not willing to settle because she is still having sx that started immediately after the accident).  Anyways, her PCP coded it as a " New Patient Office Visit. "   She had seen him within the previous year (2009) multiple times.  When I asked the billing department today (he outsources), she told me that he codes it as a new patient office visit because he creates an entirely separate chart for patients for WC and MVA's.  Now, I think it's totally stupid to do this on so many levels, but, my question is - can he charge it as a new patient visit?  My contention is not, but I would love to be enlightened because we never charge patients as a new patient office visit for WC or MVA (mainly because we keep only one chart per patient - electronically).  Obviously he has been billing this way and getting away with it for many years (and MVA's typically pay 100% of charges around here and a new patient is more than an existing patient visit).  If it's kosher to do this, we have been letting $100's slide past us every year.  But ethically, I do not think it's kosher.....would love to hear from some of you about this!

 

Thanks,

--

Pratt

Oak Tree Internal Medicine, PC

2301 Camino Ramon, Suite 290

San Ramon, CA 94583

p.

f.

c.

www.prattmd.info

 

[Guest guest]

,Doing a Google search, I found this discussion on what appears to be a forum for professional coders:http://www.aapc.com/memberarea/forums/archive/index.php?t-35870.htmlwhich led me to a North Carolina state government site:http://www.ic.nc.gov/ncic/pages/feesec03.htmI found a section there that gives this definition:New PatientA new patient is one who is new to the physician or an established patient with a new industrial injury or condition (highlights are mine). Only one new patient visit is reimbursable to a single physician or medical group per specialty for evaluation of the same patient relating to the same incident, injury, or illness.So it would appear that at least in some states, an established patient can still be considered a "new patient" if they have a new injury that is being treated under Worker's Comp. I don't know if that applies to California. SetoSouth Pasadena, CA

At the "big groups" I worked in before, it was done that way. Worker's Comp records had to be kept in second chart and the new patient charge is presumably for setting that up. I can't guantee that this was reviewed with legal and/or billing experts, but they tended to on decisions like that. I haven't been doing it in my IMP; never thought about it until you raised the issue.

Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com

I'm helping my mom go through her reams of medical bills from the past year and a half. She was rear-ended in her car in January, 2010. She saw her PCP 2-3 days after the accident when she wasn't starting to feel better. She just got a bill (we don't know why the auto insurance has not yet paid other than we are still contending that we are not willing to settle because she is still having sx that started immediately after the accident). Anyways, her PCP coded it as a "New Patient Office Visit." She had seen him within the previous year (2009) multiple times. When I asked the billing department today (he outsources), she told me that he codes it as a new patient office visit because he creates an entirely separate chart for patients for WC and MVA's. Now, I think it's totally stupid to do this on so many levels, but, my question is - can he charge it as a new patient visit? My contention is not, but I would love to be enlightened because we never charge patients as a new patient office visit for WC or MVA (mainly because we keep only one chart per patient - electronically). Obviously he has been billing this way and getting away with it for many years (and MVA's typically pay 100% of charges around here and a new patient is more than an existing patient visit). If it's kosher to do this, we have been letting $100's slide past us every year. But ethically, I do not think it's kosher.....would love to hear from some of you about this!

Thanks,

--

Pratt

Oak Tree Internal Medicine, PC

2301 Camino Ramon, Suite 290

San Ramon, CA 94583

p.

f.

c.

www.prattmd.info

[Guest guest]

Thanks for the replies.  This definitely isn't Worker's Comp - it was an Auto accident.  I haven't been able to find anything that supports that it's ok to do so.

 

, Doing a Google search, I found this discussion on what appears to be a forum for professional coders: http://www.aapc.com/memberarea/forums/archive/index.php?t-35870.html

which led me to a North Carolina state government site:

http://www.ic.nc.gov/ncic/pages/feesec03.htm

I found a section there that gives this definition:

New Patient

A new patient is one who is new to the physician or an established patient with a new industrial injury or condition (highlights are mine).  Only one new patient visit is reimbursable to a single physician or medical group per specialty for evaluation of the same patient relating to the same incident, injury, or illness.

So it would appear that at least in some states, an established patient can still be considered a " new patient " if they have a new injury that is being treated under Worker's Comp. I don't know if that applies to California.

Seto

South Pasadena, CA

 

At the " big groups " I worked in before, it was done that way.  Worker's Comp records had to be kept in second chart and the new patient charge is presumably for setting that up.  I can't guantee that this was reviewed with legal and/or billing experts, but they tended to on decisions like that.  I haven't been doing it in my IMP; never thought about it until you raised the issue.

Sharon

Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA  92617PH: (949)387-5504   Fax: (949)281-2197  Toll free phone/fax: 

www.SharonMD.com

 

I'm helping my mom go through her reams of medical bills from the past year and a half.  She was rear-ended in her car in January, 2010.  She saw her PCP 2-3 days after the accident when she wasn't starting to feel better.  She just got a bill (we don't know why the auto insurance has not yet paid other than we are still contending that we are not willing to settle because she is still having sx that started immediately after the accident).  Anyways, her PCP coded it as a " New Patient Office Visit. "   She had seen him within the previous year (2009) multiple times.  When I asked the billing department today (he outsources), she told me that he codes it as a new patient office visit because he creates an entirely separate chart for patients for WC and MVA's.  Now, I think it's totally stupid to do this on so many levels, but, my question is - can he charge it as a new patient visit?  My contention is not, but I would love to be enlightened because we never charge patients as a new patient office visit for WC or MVA (mainly because we keep only one chart per patient - electronically).  Obviously he has been billing this way and getting away with it for many years (and MVA's typically pay 100% of charges around here and a new patient is more than an existing patient visit).  If it's kosher to do this, we have been letting $100's slide past us every year.  But ethically, I do not think it's kosher.....would love to hear from some of you about this!

 

Thanks,

--

Pratt

Oak Tree Internal Medicine, PC

2301 Camino Ramon, Suite 290

San Ramon, CA 94583

p.

f.

c.

www.prattmd.info

 

--

Pratt

Oak Tree Internal Medicine, PC

2301 Camino Ramon, Suite 290

San Ramon, CA 94583

p.

f.

c.

www.prattmd.info

 

[Guest guest]

Is it possible that the auto insurance medical payment limit on the policy has already been paid to another provider? Most insurance policies have a $ 1-10K med pay amount which is the limits without settlement that the insurance company will pay to a medical provider. In this day and age, this amount is expended in the ER before anyone else ever sees the patient. I just went thru this with my daughter. We carried $10K med pay coverage and 100k per person/ 300k per incident coverage. The med pay was exhausted by the ER and the radiologist charges for her x-rays and CT scan as well as the admitting doctor charges. When all was added up $9825 of the 10K was paid out in the 1st 3 days for her ER care, ortho surgery and admitting doctor charges. No further amounts have been paid and the reason we have been given by the insurance is because the med pay benefit has been exhausted. Dr. Beth Sullivan, DO From: [mailto: ] On Behalf Of PrattSent: Thursday, June 16, 2011 10:14 PMTo: Subject: Re: Auto Insurance Billing Thanks for the replies. This definitely isn't Worker's Comp - it was an Auto accident. I haven't been able to find anything that supports that it's ok to do so. , Doing a Google search, I found this discussion on what appears to be a forum for professional coders: http://www.aapc.com/memberarea/forums/archive/index.php?t-35870.html which led me to a North Carolina state government site:http://www.ic.nc.gov/ncic/pages/feesec03.htm I found a section there that gives this definition:New PatientA new patient is one who is new to the physician or an established patient with a new industrial injury or condition (highlights are mine). Only one new patient visit is reimbursable to a single physician or medical group per specialty for evaluation of the same patient relating to the same incident, injury, or illness.So it would appear that at least in some states, an established patient can still be considered a " new patient " if they have a new injury that is being treated under Worker's Comp. I don't know if that applies to California. SetoSouth Pasadena, CA At the " big groups " I worked in before, it was done that way. Worker's Comp records had to be kept in second chart and the new patient charge is presumably for setting that up. I can't guantee that this was reviewed with legal and/or billing experts, but they tended to on decisions like that. I haven't been doing it in my IMP; never thought about it until you raised the issue.Sharon Sharon McCoy MDRenaissance Family Medicine10 McClintock Court; Irvine, CA 92617PH: (949)387-5504 Fax: (949)281-2197 Toll free phone/fax: www.SharonMD.com I'm helping my mom go through her reams of medical bills from the past year and a half. She was rear-ended in her car in January, 2010. She saw her PCP 2-3 days after the accident when she wasn't starting to feel better. She just got a bill (we don't know why the auto insurance has not yet paid other than we are still contending that we are not willing to settle because she is still having sx that started immediately after the accident). Anyways, her PCP coded it as a " New Patient Office Visit. " She had seen him within the previous year (2009) multiple times. When I asked the billing department today (he outsources), she told me that he codes it as a new patient office visit because he creates an entirely separate chart for patients for WC and MVA's. Now, I think it's totally stupid to do this on so many levels, but, my question is - can he charge it as a new patient visit? My contention is not, but I would love to be enlightened because we never charge patients as a new patient office visit for WC or MVA (mainly because we keep only one chart per patient - electronically). Obviously he has been billing this way and getting away with it for many years (and MVA's typically pay 100% of charges around here and a new patient is more than an existing patient visit). If it's kosher to do this, we have been letting $100's slide past us every year. But ethically, I do not think it's kosher.....would love to hear from some of you about this! Thanks,-- PrattOak Tree Internal Medicine, PC2301 Camino Ramon, Suite 290San Ramon, CA 94583p.f. c. www.prattmd.info -- PrattOak Tree Internal Medicine, PC2301 Camino Ramon, Suite 290San Ramon, CA 94583p.f. c. www.prattmd.info

[Guest guest]

Hmm...don't think that is the case. She did not go to ER and I think the only thing billed to the auto insurance was this one $250 visit.  I really think they are waiting to see if there are more claims before they pay.

 

Is it possible  that the auto insurance medical payment limit on the policy has already been paid to another provider?  Most insurance policies have a $ 1-10K med pay amount which is the limits without settlement that the insurance company will pay to a medical provider.  In this day and age,  this amount is expended in the ER before anyone else ever sees the patient.  I just went thru this with my daughter.  We carried $10K med pay coverage and 100k per person/ 300k per incident coverage.  The med pay was exhausted by the ER and the radiologist charges for her x-rays and CT scan as well as the admitting doctor charges.  When all was added up $9825 of the 10K was paid out in the 1st 3 days for her ER care, ortho surgery and admitting doctor charges.  No further amounts have been paid and the reason we have been given by the insurance is because the med pay benefit has been exhausted. 

 

Dr. Beth Sullivan, DO