Hello,
I have looked over several posts but cannot seem to find one that answers my questions specifically.
Our clinic extends copay/pt. resp. waivers for follow up visits. (or policy is within 7 days of last DOS). That could include re-checks, suture removals, or incorrect lab testing, etc.
Most of the times the visits do not last very long (under 10-15 minutes), but sometimes the doctors do see the patient for a bit longer than that and attempt to treat them further if what was treated on the previous DOS did not work.
For our staff that has insurance, they waive the copay/pt resp. and bill the insurance as well. I am told that if you do that, the visit should be waived in its entirety and not billed to the insurance company—but if you have a contract with the insurance company, every visit needs to be billed to them.
As I learn about billing and coding compliances and laws, I am realizing that this is fraud and I want to raise these issues with the doctors and the other billing staff.
My question is, if a clinic wants to extend follow up waivers to their patients (or waivers in general to their employees and families w/ INS) how can they do that legally without violating their insurance contract or breaking any federal law?
I have looked over several posts but cannot seem to find one that answers my questions specifically.
Our clinic extends copay/pt. resp. waivers for follow up visits. (or policy is within 7 days of last DOS). That could include re-checks, suture removals, or incorrect lab testing, etc.
Most of the times the visits do not last very long (under 10-15 minutes), but sometimes the doctors do see the patient for a bit longer than that and attempt to treat them further if what was treated on the previous DOS did not work.
For our staff that has insurance, they waive the copay/pt resp. and bill the insurance as well. I am told that if you do that, the visit should be waived in its entirety and not billed to the insurance company—but if you have a contract with the insurance company, every visit needs to be billed to them.
As I learn about billing and coding compliances and laws, I am realizing that this is fraud and I want to raise these issues with the doctors and the other billing staff.
My question is, if a clinic wants to extend follow up waivers to their patients (or waivers in general to their employees and families w/ INS) how can they do that legally without violating their insurance contract or breaking any federal law?