Wiki Code for Review of Records by Physician NOT seeing a Medicare patient

[jveronick]

I am curious about something we are trying to figure out.

My doctor is often asked to review records for patients from out of state due to a study he is doing. In the past he has done these for free, but they are taking up enough time that we are now going to implement a charge for these reviews for private insurance patients.

While we fully realize that we cannot do this for Medicare patients, I was wondering if we could use an ABN to notify them of the fact that Medicare will not pay for this review of records and that the patient will be directly responsible for this charge. From my understanding of how ABNs work, an ABN is used to notify the patient of something that might not be covered under Medicare. Am I understanding correctly that we could possibly use the ABN as a way to charge Medicare patients? This would solely be a records review - we would not be seeing the Medicare patients.

I'm not trying to do anything hinky here. Just want to be able to allow Medicare patients to also have their records reviewed because the kind of things we are reviewing for often occurs more in Medicare-aged patients anyway.

I'd appreciate having anyone who's a Medicare billing and ABN expert weigh in on this.

Julie Veronick, CMPE, CPC

 

[mitchellde]

I am curious about something we are trying to figure out.

My doctor is often asked to review records for patients from out of state due to a study he is doing. In the past he has done these for free, but they are taking up enough time that we are now going to implement a charge for these reviews for private insurance patients.

While we fully realize that we cannot do this for Medicare patients, I was wondering if we could use an ABN to notify them of the fact that Medicare will not pay for this review of records and that the patient will be directly responsible for this charge. From my understanding of how ABNs work, an ABN is used to notify the patient of something that might not be covered under Medicare. Am I understanding correctly that we could possibly use the ABN as a way to charge Medicare patients? This would solely be a records review - we would not be seeing the Medicare patients.

I'm not trying to do anything hinky here. Just want to be able to allow Medicare patients to also have their records reviewed because the kind of things we are reviewing for often occurs more in Medicare-aged patients anyway.

I'd appreciate having anyone who's a Medicare billing and ABN expert weigh in on this.

Julie Veronick, CMPE, CPC

I understand what you are wanting to do however, I don’t think it is correct to charge a patient to review their records just because your provider selected them as a part of a study. Did the patient request that their old charts be reviewed? Did the payer request that these be reviewed? Is the review directly relayed to the physician treatment of this patient and can the provider show that this review was medically necessary to better care for the patient. If you cannot answeryesto these questions then you cannot charge the patient or the payer. If the provider is performing a study then if it is for his own information, there is no reimbursement for the time invested. If the study is for an outside entity then that is who shpuld be paying for the providers time.