Medical Billing Forum

Billing => Billing => Topic started by: MBP on February 01, 2010, 09:17:52 AM

Title: medicare E&M billing question
Post by: MBP on February 01, 2010, 09:17:52 AM
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..
Title: Re: medicare E&M billing question
Post by: Michele on February 01, 2010, 09:31:21 AM
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
Title: Re: medicare E&M billing question
Post by: Pay_My_Claims on February 01, 2010, 10:21:44 AM
http://www.arkmedicare.com/provider/viewarticle.aspx?articleid=6947


http://www.acpinternist.org/archives/2000/05/prevention.htm
Title: Re: medicare E&M billing question
Post by: MBP on February 01, 2010, 11:19:59 AM
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..
Title: Re: medicare E&M billing question
Post by: Michele on February 02, 2010, 06:57:39 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
Title: Re: medicare E&M billing question
Post by: MBP on February 02, 2010, 08:29:33 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.  >:(
Title: Re: medicare E&M billing question
Post by: Michele on February 02, 2010, 09:53:16 AM
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