Practice Management Alert

Question: My office’s physician performs a depression screening on some patients once a year, and some of these claims get denied while others are fine. Is there some possible reason this is happening on the payers’ end?

Iowa Subscriber

Answer: Yes, it’s possible that some patients have other providers who are doing these screenings and submitting claims to the patient’s insurance. You and your physician may know that some screenings can be performed with certain frequency — but the frequency is tied to the patient, not the provider.

For screenings like depression screening, “frequency means how many times a patient can have it a year, not how many times a doctor can perform it,” says Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMCSC, CMCS, ACS-CA, SCP-CA, owner of Terry Fletcher Consulting Inc. and consultant, auditor, educator, author, and podcaster at Code Cast, in Laguna Niguel, California.

If your physician’s claim is being denied for a particular patient, then that patient’s other providers may have tried to submit a claim for the same screening service.