Re: eob for recent annual exam

[Guest guest]

Lonna,From what I can see, Q0091 is a code only used for Medicare patients. You don't have Medicare, do you? Sure seems overly expensive to me. When I see fellow physicians as patients, I give Professional Courtesy and accept whatever insurance pays (unless insurance doesn't pay anything).If you provide a well-woman exam for a Medicare patient, you should report G0101 (cervical or vaginal cancer screening; pelvic and clinical breast examination) for the breast and pelvic exams. When you also obtain a Pap smear, use Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory), says Carol Pohlig, a coding specialist at the University of Pennsylvania Medical Center in Philadelphia.http://medicaleconomics.modernmedicine.com/memag/Young+Doctors'+Resource+Center:+Practice+Management:+Coding/Coding-Consult/ArticleStandard/Article/detail/182796 SetoSouth Pasadena, CAAck! I have no idea how that sent. Anyway, the EOB says:(Sorry if this formats weird)Service Amount billed Amount allowed Amount we paidWell care99396 322.00 322.00 297.00Pap (collection fee?)Q0091 60.00 0.00 0.00Pap88142 90.00 79.65 79.65Well CareA4649 9.35 0.00 0.00 So, anyway you slice it, it's a lot of money, but it's not $545.LonnaWhat's a Q0091 and an A4649?Are those the parts where my medicines didn't get called in right or the surcharge for not being albe to reach my doctor? I'm sorry, there I go being sarcastic again. My kids hate that.

[Guest guest]

Forgot to include the link for the Q0091 reference below: Medical EconomicsA4649 is "© A4649, Surgical supply; miscellaneous, includes, but is not limited to antiseptic towelettes. http://www.dhs.state.or.us/policy/healthplan/history/dme/dme4b-0403.pdf SetoSouth Pasadena, CALonna,From what I can see, Q0091 is a code only used for Medicare patients. You don't have Medicare, do you? Sure seems overly expensive to me. When I see fellow physicians as patients, I give Professional Courtesy and accept whatever insurance pays (unless insurance doesn't pay anything).If you provide a well-woman exam for a Medicare patient, you should report G0101 (cervical or vaginal cancer screening; pelvic and clinical breast examination) for the breast and pelvic exams. When you also obtain a Pap smear, use Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory), says Carol Pohlig, a coding specialist at the University of Pennsylvania Medical Center in Philadelphia.

[Guest guest]

Are these codes Q0091 and A4649 this clinics way of slipping in some generic coding to see if they get paid -- or if they don't, the patient is left on the hook?

Doubt the insurance is going to pay for A4649 is "© A4649, Surgical supply; miscellaneous, includes, but is not limited to antiseptic towelettes.

So the patient is left holding the bag for that fee -- possibly.

It doesn't look like either of those were covered by insurance.

Locke, MD

From: [mailto: ] On Behalf Of SetoSent: Wednesday, June 18, 2008 4:08 PMTo: Subject: Re: eob for recent annual exam

Forgot to include the link for the Q0091 reference below: Medical Economics

A4649 is "© A4649, Surgical supply; miscellaneous, includes, but is not

limited to antiseptic towelettes.

http://www.dhs.state.or.us/policy/healthplan/history/dme/dme4b-0403.pdf

Seto

South Pasadena, CA

Lonna,

From what I can see, Q0091 is a code only used for Medicare patients. You don't have Medicare, do you? Sure seems overly expensive to me. When I see fellow physicians as patients, I give Professional Courtesy and accept whatever insurance pays (unless insurance doesn't pay anything).

If you provide a well-woman exam for a Medicare patient, you should report G0101 (cervical or vaginal cancer screening; pelvic and clinical breast examination) for the breast and pelvic exams. When you also obtain a Pap smear, use Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory), says Carol Pohlig, a coding specialist at the University of Pennsylvania Medical Center in Philadelphia.

[Guest guest]

No, no Medicare yet.

When I worked for this group, I recall being told that it was against some Medicare law to give ANYONE any kind of discount. If you gave anyone a discount, you had to give everyone a discount. They do have some complicated process to apply for reduced fees with lots of paperwork but that is between the billing office and the patient, the doc has no say in this whatsoever. Back before the group got very large, individual docs could give discounts as they saw fit, but as the group got larger, that became outlawed.

Lonna

Ack! I have no idea how that sent. Anyway, the EOB says:

(Sorry if this formats weird)

Service Amount billed Amount allowed Amount we paid

Well care

99396 322.00 322.00 297.00

Pap (collection fee?)

Q0091 60.00 0.00 0.00

Pap

88142 90.00 79.65 79.65

Well Care

A4649 9.35 0.00 0.00

So, anyway you slice it, it's a lot of money, but it's not $545.

Lonna

What's a Q0091 and an A4649?

Are those the parts where my medicines didn't get called in right or the surcharge for not being albe to reach my doctor? I'm sorry, there I go being sarcastic again. My kids hate that.

[Guest guest]

So what is it that makes their 99396 worth nearly 3 times as much as

my 99396?

>

> Ack! I have no idea how that sent. Anyway, the EOB says:

> (Sorry if this formats weird)

> Service Amount billed Amount allowed Amount we paid

> Well care

> 99396 322.00 322.00 297.00

> Pap (collection fee?)

> Q0091 60.00 0.00 0.00

> Pap

> 88142 90.00 79.65 79.65

> Well Care

> A4649 9.35 0.00 0.00

>

> So, anyway you slice it, it's a lot of money, but it's not $545.

> Lonna

> What's a Q0091 and an A4649?

> Are those the parts where my medicines didn't get called in right

or the surcharge for not being albe to reach my doctor? I'm sorry,

there I go being sarcastic again. My kids hate that.

>

>

>

[Guest guest]

My guess: a profound lack of shame.So what is it that makes their 99396 worth nearly 3 times as much asmy 99396?>> Ack! I have no idea how that sent. Anyway, the EOB says:> (Sorry if this formats weird)> Service Amount billed Amount allowed Amount we paid> Well care> 99396 322.00 322.00 297.00> Pap (collection fee?)> Q0091 60.00 0.00 0.00> Pap> 88142 90.00 79.65 79.65> Well Care> A4649 9.35 0.00 0.00> > So, anyway you slice it, it's a lot of money, but it's not $545.> Lonna> What's a Q0091 and an A4649?> Are those the parts where my medicines didn't get called in rightor the surcharge for not being albe to reach my doctor? I'm sorry,there I go being sarcastic again. My kids hate that.> > >

[Guest guest]

RE discount for same day cash payors.

If pt is paying ENTIRE amount either as cash OR deductable, I give "10% off total same day same as cash".

My billing co says we can apply the ENTIRE AMOUNT BEFORE DISCOUNT to the deductable, but the discount of 10% is between ME and the PT.

This also works as NONE of my insurances pay my rate at 90%, but my pts are very happy to get this.

Insurance NEVER pays same day...............

Matt in Western PA

Re: Re: eob for recent annual exam

Helen

I leave that up to the insurance company. The discount is available to them if they can figure it out. Their discount is just about the same as what I offer anyway. THe thought is that the offering makes it equitable for everyone and therefore legal. I do have some people who use their HSA card to pay for the visit and some of that money is often paid into the account by the insurance company. In the end no matter who pays the bill is paid on the same day and that is a benefit for me, thus the discount.

Rene

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[Guest guest]

Yes, true. But the insurance company has gone along with this. What's

their excuse?

>

> My guess: a profound lack of shame.

[Guest guest]

ahh.An fp who understands her own fp.

I know what happened because I was in the same crappy system that she is stuck in now. The EMR that they use is Epic, if anyone knows what it is like.The entire annual exam visit including all possible codes one might choose, immunizations one might give, all patient education one might want to print up, etc, are on a very large template. The doc just clicks away. It's rather confusing, at least at first. She has been using this system now for about a year and a half, so she should have gotten it down by now. But ... she is in the middle of an ugly, expensive divorce, trying to raise her 2 year old daughter in a very antagonistic environment, in a heartless practice. She doesn't personally set her fees. She got distracted and forgot that she didn't do a pap. I am giving her a big benefit of the doubt here. I have

decided that I am not going to go to her anymore, not because of her personally, but because I can't support her group anymore. I think I will write her a letter telling her what happened and why I won't be seeing her anymore. I am really kind of sad about it, but just like with every other consumer decision I make, I have to take my business where I feel better about what I am spending my money on.

Remember my recent rant about my visit to my doctor and how she charged $545?

I got the EOB and here's the whole story.

First of all, the charge was " only " 481.35; I either misquoted my husband, or he gave me the wrong number. The number that I was using came from the insurance company form that they send out when you use new insurance asking if you have other new insurance. (The form that says, " We see that you have used your insurance, as we have been billed $481.35. We are hoping you have other insurance so we don't have to pay ... Do you?) My dear husband filled out the form informing them that we don't have other insurance, so they did pay, and now I have received the EOB which says:

Service

-- If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/

MD

ph fax

-- If you are a patient please allow up to 4-8 hours for a reply by email/please note the new email address/e mail may not be entirely secure/ MD

ph fax