Practice Management Alert

Plan your coding, payment policy attack now

You can avoid losing reimbursement for spring and summer physicals if you implement these expert strategies:
 
1. Collect Payment Up-Front. You should inform parents that, unlike annual preventive medicine services, sports and camp physicals are usually noncovered services.

Blue Cross Blue Shield sometimes inquires about the reason for a well exam, says Tammy Trench, CPC, accounts receivable technical adviser at Apex Practice Management in Oklahoma City. "But when the representative finds out the visit is for a sports exam, the insurer won't cover the service."

Solution: You can charge the parent cash up-front for the service. "Most parents are happy to pay the $15 that we charge for the physician's child evaluation and form completion," Trench says.

2. Combine Annual and Sports Exam. You can recoup preventive exam pay if your patients present for their annual exam when they require a sports or camp form. "Patients often need a spring and fall sports exam, plus a preventive exam for school," says Merlinda Craig, CPC, at Bon Secours Health Partners in Shohola, Pa. "We encourage parents to schedule their child's annual comprehensive preventive medicine service at the same time the child needs a sports or camp exam."

Benefit: Insurers typically cover 99382-99385 and 99392-99395 annually, so you should collect reimbursement for the service.

Example: An established 12-year-old boy requires his annual exam and a sports exam to play junior-high soccer. You should use 99394 (Periodic comprehensive preventive medicine reevaluation and management ... established patient; adolescent [age 12 through 17 years]) for this service. Assign the routine general medical examination code V70.0 (Routine general medical examination at a healthcare facility) to inform the insurer that the physician performed a health checkup.

3. Use Exam to Complete Form. You may also use the preventive medicine service exam information to fill out the sports or camp form, but you probably can't charge separately for this. "If a nurse completes the form, we normally don't charge for the service," Craig says.

Pitfall: For liability reasons, your physician may not want to issue a form without checking the patient to see if his status has changed.