dballard2004
True Blue
Has anyone else experieinced this before.....I am speaking here about retail clinics.
We have a specific payer that will not allow mid level providers (mainly NPs) to bill anything higher than a 99213. Even if the visit meets the criteria and medical necessity for a 99214 or 99215, we have to downcode to a level 3 visit. This payer's rationele is that retail clinics are not intended to take the place of or act as a PCP's office and are only intended to be used as a convenience for certain services.
I have experienced this before with other payers and mid level providers in a physician's office.
My mid level providers who work on the retail side are angry and upset by this. They are questioning if this is legal and how this payer can tell us that we can't code our patients as a 99214 if it is warranted. Personally, I have experienced this before, so I don't think we have a leg to stand on here, but I am curious about what other think of this.
Thanks.
We have a specific payer that will not allow mid level providers (mainly NPs) to bill anything higher than a 99213. Even if the visit meets the criteria and medical necessity for a 99214 or 99215, we have to downcode to a level 3 visit. This payer's rationele is that retail clinics are not intended to take the place of or act as a PCP's office and are only intended to be used as a convenience for certain services.
I have experienced this before with other payers and mid level providers in a physician's office.
My mid level providers who work on the retail side are angry and upset by this. They are questioning if this is legal and how this payer can tell us that we can't code our patients as a 99214 if it is warranted. Personally, I have experienced this before, so I don't think we have a leg to stand on here, but I am curious about what other think of this.
Thanks.