Pediatric Coding Alert

These AAP-endorsed measures will help you charge phone services ethically without causing patient ill-will Before you start billing for telephone-care services, sit down with staff and develop a telephone-care policy that teaches proper documentation, qualifying encounters, and reimbursement issues.

"You need to set a policy on when you charge and then educate staff and patients," says Joel Bradley Jr., MD, pediatrician at Premier Medical Group in Clarksville, Tenn.

Discuss implementing these payment measures:

Step 1: Inform representatives that you will be coding for telephone services and that the American Academy of Pediatrics (AAP) backs reimbursement for such services by payers, including state Medicaid agencies.

Step 2: Negotiate fee schedules and/or capitated rates for telephone-care payment at contract renewal time, says Victoria S. Jackson, practice management consultant with JCM Inc. in California. Don't meet denials with ceased reporting. Instead: Keep billing insurers to demonstrate code use and track services.

Step 3: Know payment methods for existing nonpaying contracts. When a payer considers telephone care uncovered, but allowed -- not bundled, consider billing the patient.

Step 4: Notify patients of the types of calls you will be charging for and any financial responsibility they may incur, Bradley says. Explain ways the patient can avoid such fees, such as coming in for a face-to-face service.

Step 5: Consider creating per-call rates and prepaid monthly telephone access fees -- two methods the AAP advocates.