Medical Billing Forum

Billing => Billing => : MBP February 01, 2010, 12:17:52 PM

: medicare E&M billing question
: MBP February 01, 2010, 12:17:52 PM
this may be a stupid question.. does medicare have various coverage plans within plan A and plan B? i just received an RA with a rejection for 99205 saying non-covered charges.. i always thought there was only plan A and plan B and benefits for all people covered by those plans were same..
: Re: medicare E&M billing question
: Michele February 01, 2010, 12:31:21 PM
There is Medicare Part A & Part B.  Part A is for facility fees, Part B is for professional fees.  There must be another denial code on the eob stating the reason that the 99205 is not a covered service.

Michele
: Re: medicare E&M billing question
: Pay_My_Claims February 01, 2010, 01:21:44 PM
http://www.arkmedicare.com/provider/viewarticle.aspx?articleid=6947


http://www.acpinternist.org/archives/2000/05/prevention.htm
: Re: medicare E&M billing question
: MBP February 01, 2010, 02:19:59 PM
thank you Michele and Charlene, i figured switching from consultation codes to new patient ones will not be that easy... all the instructions i have read said go for new patient office codes so i dont get it - why the denials now? what should i do now? appeal it? it was for the consult that would have been billed as 99245..
: Re: medicare E&M billing question
: Michele February 02, 2010, 09:57:39 AM
If the patient is not a new patient to your office you need to use established patient code.  If the patient was seen in the past 2 years, Medicare will not allow another new patient visit.

Michele
: Re: medicare E&M billing question
: MBP February 02, 2010, 11:29:33 AM
the patient is a new patient, never before seen in this office. he was referred for consultation... i will just try to send it out again i guess and if it gets rejected again i can call them.  >:(
: Re: medicare E&M billing question
: Michele February 02, 2010, 12:53:16 PM
Isn't there another rejection code on the eob?  The 'non covered service' is a generic one.  There should be a more specific one.

Michele