Colliemom
Expert
We are running into a problem and we are wondering if anyone else is having a similar problem.
We are asked to see residents of nursing homes in consultation. We fax them the paperwork to fill out, which includes a review of system. Frequently the nursing homes fax the paperwork back to us blank, and without a review of systems the highest level we could bill is a 99241. They are VERY resistant to filling out paperwork for their residents.
The patient is brought into the office, and is accompanied by an employee of the nursing home. Typically this employee is not the caregiver of the patient; he/she is really just a chaperone, so they cannot provide any of the patient's medical history/review of systems.
The patients are usually suffering from some form of dementia, and are unable to provide answers to a review of systems.
Our providers are spending 60+ minutes with these patients, and because the patient has dementia we cannot bill counseling. Our providers will call the nursing home and family members during the visit to ask questions. But because the nursing home caregiver and/or family members are not present, we cannot bill counseling as that requires face-to-face contact. And we are unsure if this would meet the criteria/guidelines for billing coordination of care. (again, because this all takes place over the phone during the patient's visit to the office)
So is anyone else having a similar problem? How do you handle it? Do you refuse to see the patient without the proper paperwork? Do you obtain the history and/or ROS over the phone with someone at the Nursing Home? Do you think this would be considered coordination of care?
We are asked to see residents of nursing homes in consultation. We fax them the paperwork to fill out, which includes a review of system. Frequently the nursing homes fax the paperwork back to us blank, and without a review of systems the highest level we could bill is a 99241. They are VERY resistant to filling out paperwork for their residents.
The patient is brought into the office, and is accompanied by an employee of the nursing home. Typically this employee is not the caregiver of the patient; he/she is really just a chaperone, so they cannot provide any of the patient's medical history/review of systems.
The patients are usually suffering from some form of dementia, and are unable to provide answers to a review of systems.
Our providers are spending 60+ minutes with these patients, and because the patient has dementia we cannot bill counseling. Our providers will call the nursing home and family members during the visit to ask questions. But because the nursing home caregiver and/or family members are not present, we cannot bill counseling as that requires face-to-face contact. And we are unsure if this would meet the criteria/guidelines for billing coordination of care. (again, because this all takes place over the phone during the patient's visit to the office)
So is anyone else having a similar problem? How do you handle it? Do you refuse to see the patient without the proper paperwork? Do you obtain the history and/or ROS over the phone with someone at the Nursing Home? Do you think this would be considered coordination of care?
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