If a patient has a MedAdvantage plan that covers annual exams, do they follow the same guidelines as Medicare? Medicare states the problem visit can be subtracted from the annual exam price and the pt's charged the difference to cover the work above & beyond the problem visit. For a Medicare pt, we can support a 99214 since whatever's left over goes to the annual. For a commercial payer, the annual would be the first charge and whatever's left over would go to support the problem visit. Unless their guidelines prohibit it, they would pay both, since they would expect there to be 2 separately identifiable charges documented. In this case, we wouldn't be able to support a 99214 since much of the history (non-problem related ROS & PFSH) would already be accounted for in the Annual charge.
So, would MedAdvantage plans expect the documentation to look like Medicare's (office visit subtracted from a/e) or like a commercial's requirements (office visit separate from a/e)? I'd appreciate any insight. Thanks!
So, would MedAdvantage plans expect the documentation to look like Medicare's (office visit subtracted from a/e) or like a commercial's requirements (office visit separate from a/e)? I'd appreciate any insight. Thanks!