Re: Nurse billing question

[Guest guest]

I 2nd Kathy's opinion - 99211.  But warn your patients, as they will have a copay for this.  And it gets tricky because sometimes the patient copay is HIGHER than the allowed amount for a 99211.  If that isn't crazy, I don't know what is!!!

 

 

I imagine you could bill a 99211 for “nurse visit” or visit not requiring doctor’s services. 

 

 

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

 

 

 

From: [mailto: ] On Behalf Of Dr. Brady

Sent: Tuesday, November 29, 2011 1:12 PMTo: Subject: Nurse billing question

 

 

Guys,

I have hired a nurse part time (like 10 hours a week or less) to do patient education for my patients who are not confident in the management of their disease. She is starting with the diabetics, but will certainly be able to discuss weight loss, low cholesterol diet, stress management, etc depending on the wants and needs of the patient. My question—is it possible to bill insurance for this service? My nurse is not a certified diabetic educator so we can’t bill for that. I know I could peak my head in and bill that way, but that doesn’t seem altogether honest. I know we could do this as a group type visit, but we are just starting as individual sessions first. Thoughts??

P.S. I am going to keep the project going whether I can get reimbursement for it or not as I think it is a cool way to improve the health of my patients. But, of course, it would be nicer if it were revenue neutral. J

-- Pratt

[Guest guest]

Yep. I thought about doing it that way, but realized the same issues—both about the copay and the stupidity around the reimbursement. I think I might just tell patients the following:“Having an appointment with the nurse educator is not a covered benefit under your insurance. Therefore, there will be a $25 charge for each one hour session. If this fee will cause a financial hardship, let us know so we can wave it. After all, improving your health is our primary objective.”I figure this way, there will be some revenue generated (though probably not enough to break even) and I don’t have to worry about insurance insanities. I also send a not so subtle message to the patients that I am not just in this for the money. I figure that is always a good message to send. JThanks for your thoughts! From: [mailto: ] On Behalf Of PrattSent: Tuesday, November 29, 2011 4:52 PMTo: Subject: Re: Nurse billing question I 2nd Kathy's opinion - 99211. But warn your patients, as they will have a copay for this. And it gets tricky because sometimes the patient copay is HIGHER than the allowed amount for a 99211. If that isn't crazy, I don't know what is!!! I imagine you could bill a 99211 for “nurse visit” or visit not requiring doctor’s services. Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing From: [mailto: ] On Behalf Of Dr. BradySent: Tuesday, November 29, 2011 1:12 PMTo: Subject: Nurse billing question Guys,I have hired a nurse part time (like 10 hours a week or less) to do patient education for my patients who are not confident in the management of their disease. She is starting with the diabetics, but will certainly be able to discuss weight loss, low cholesterol diet, stress management, etc depending on the wants and needs of the patient. My question—is it possible to bill insurance for this service? My nurse is not a certified diabetic educator so we can’t bill for that. I know I could peak my head in and bill that way, but that doesn’t seem altogether honest. I know we could do this as a group type visit, but we are just starting as individual sessions first. Thoughts??P.S. I am going to keep the project going whether I can get reimbursement for it or not as I think it is a cool way to improve the health of my patients. But, of course, it would be nicer if it were revenue neutral. J-- Pratt