Medicare Compliance & Reimbursement

Question: We have a patient who did not have a urinalysis done at his previous well visit, but then needed it done for his basketball camp form. The patient did not have any problems or issues with urination, just needed it for his camp form records. What diagnosis code could we use to submit this service to his insurance company? If we use the well child diagnosis code, the insurance may not pay for the actual well visit diagnosis code when the patient needs it. Answer: Unfortunately, you will likely not be reimbursed by the insurance company for this service. Most payers will not reimburse a urinalysis for a camp form when there is no other reason for the urinalysis. Under these circumstances, consider collecting from the patient -- probably $5-$10 based on the payer’s fee schedule -- and then reimburse the patient if the submitted claim is paid. You may also [...]