myinnerchild
New
Hi all,
I have a few providers who insist on submitting billable Gcodes for weight counseling, depression discussion, tobacco counseling etc when there is "template" documentation. These template responses are generic in nature and not specific to patient case ie "patient counseled on diet and exercise". Nothing definitive to show that the provider actually spent time discussing these with the patient. For one provider he will only allow AWVs to be scheduled in 15 minute slots. We have timed him and he spends an average of 4 minutes in the room with the patient. He insists that because we have the patient fill out a questionnaire and he reviews the questionnaire, he can safely bill for those codes. Gut check tells me this is wrong and he is trying to boost his revenue and numbers due to a recent comp model change for the providers. We have reviewed the required documentation with him regarding these and other codes however, he insists he is correct. As a side note, we have complaints all the time from his patients when they see their EOB that lists these GCode services. They state comments like "we never talked about those things".
What would be our next steps to ensure compliance?
I have a few providers who insist on submitting billable Gcodes for weight counseling, depression discussion, tobacco counseling etc when there is "template" documentation. These template responses are generic in nature and not specific to patient case ie "patient counseled on diet and exercise". Nothing definitive to show that the provider actually spent time discussing these with the patient. For one provider he will only allow AWVs to be scheduled in 15 minute slots. We have timed him and he spends an average of 4 minutes in the room with the patient. He insists that because we have the patient fill out a questionnaire and he reviews the questionnaire, he can safely bill for those codes. Gut check tells me this is wrong and he is trying to boost his revenue and numbers due to a recent comp model change for the providers. We have reviewed the required documentation with him regarding these and other codes however, he insists he is correct. As a side note, we have complaints all the time from his patients when they see their EOB that lists these GCode services. They state comments like "we never talked about those things".
What would be our next steps to ensure compliance?