Wiki M/Care consults when TMHP or Comm 2nd

[ddailey]

I would like to hear how other organizations are handling the new rule on Medicare consults when:

Commercial Payer and/or Medicaid is secondary - they still accept the consult codes and should they receive more than one initial admission on the same DOS they are going to deny it.

When the 835 files I am not sure if there is a process to stop these to change the code or if that is even appropriate.

 

[jojo419]

Based on the two options Medicare presented when a secondary carrier accepts the consult code and Medicare does not... I opted for billing the accepted Medicare code. I found it more cost effective to bill the code Medicare accepts and let it go thru to the 2nd carrier.
More and more insurance companies will not accept a handwritten change/correction on a claim so there is so much extra time and cost invested. In other instances, certain claims crossover from Medicare automatically and then you are dealing with that correction.
What I am recommending to doctors is to be more specific about their time with a patient so that they can bill ethically. For example, smoking cessation counseling, 50% of E/M visit counseling, prolonged service, overlooked procedures. Often, they lump everything into a consult when there is so much more. Fortunately, access to EMR documentation helps ensure coding is accurate.
I am finding out through trial and error, as well as reading every carrier newlsetter that crosses my desk, that payers are slowly beginning to follow Medicare's guidelines. So be careful.

 

[cmcgarry]

We are billing the accepted Medicare codes to the secondary also. So far we haven't had a problem - but give it time with inpatient (office doesn't worry me much, but IP with the multiple initial visits sure does)