You Be the Expert:
Noncovered Services
Published on Mon Jul 01, 2002
Test your knowledge. Determine how you would handle this situation before looking at the box below for the answer.
Question: When my doctor performs a procedure that Medicare does not reimburse, such as conscious sedation, should I still list the service and enter a $0 charge for the proper documentation?
Maryland Subscriber
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Answer: Practices often want to keep track of services even if they are not payable. This ensures that your records are as accurate as possible in case of an audit or other financial scrutiny your practice may come under. The only way to do this is to enter the code in the computer with a zero dollar amount. This way it will be tracked in the patient's record but will not transmit to the insurance company.
Ordinarily, a physician or supplier does not bill the Medicare program for noncovered services. However, if the beneficiary (or his representative) believes that a service may be covered or desires a formal Medicare determination, the physician or supplier must file a claim for that service to effectuate the beneficiary's right to a determination. Instruct physicians or suppliers to note on the claim their belief that the service is noncovered and that it is being submitted at the beneficiary's insistence.
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