Author Topic: CAN I BILL WORKERS COMP AND MEDICARE SAME VISIT  (Read 2752 times)

sherry27

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CAN I BILL WORKERS COMP AND MEDICARE SAME VISIT
« on: December 17, 2009, 03:09:23 PM »
IF A PT HAS WC AND MEDICARE, AND HE IS SEEN FOR HIS WC INJURY, ALONG WITH HTN, DM, HYPERLIPIDEMIA ECT. , CAN I BILL BOTH INSURANCES AS LONG AS THERE ARE 2 DIFFERENT OFFICE NOTES, SINCE HE WAS SEEN FOR ALL OF THESE CONDITIONS???????? ???

Michele

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Re: CAN I BILL WORKERS COMP AND MEDICARE SAME VISIT
« Reply #1 on: December 17, 2009, 08:15:44 PM »
Basically you would bill two separate office visits, one to MCR and one to WC.  The office visit needs to be broken into two.  For example if it was a 25 minute office visit and say about 10 minutes was spent on the WC DX and 15 minutes was spent on others you would bill a 99211 to WC and a 99212 to MCR.  I'm guessing on the minutes, but you get the picture.

Michele
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sherry27

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Re: CAN I BILL WORKERS COMP AND MEDICARE SAME VISIT
« Reply #2 on: December 18, 2009, 09:24:01 AM »
THANK YOU FOR THE REPLY. I THOUGHT IT WORKED THAT WAY

Steve Verno CMBS, CEMCS

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Re: CAN I BILL WORKERS COMP AND MEDICARE SAME VISIT
« Reply #3 on: December 18, 2009, 10:25:39 PM »
To add to michelle.

One thing to remember is workers comp covers only work related injuries/illnesses.  The injury/illness cannot be as a result of taking drugs, obtained in fights or failure to follow safety rules established by the employer.  Here in Florida, an employer can deny an injury as work related.  The insurance company is tasked to investigate the injury. 

On a side note as examples, I had one wc claim denied.  The employee was a stilt walker at Universal Studios.  He claimed he fell at work. Universal denied the injury as he wasnt working when he was injured.  The employee finally admitted he fell at home.  The State proscecuted him for filing a false report. 

A second patient filed a wc claim saying she fell in the employers parking lot while on the way to her car.  The claim was denied.  The insurance company investigated.  They determined the employer didnt ow the parking lot.  It was owned by the adjacent mall.  The inurance company recommended a third party lawsuit. 

With Medicare, it is always secondary to workers comp, but they have a provisional clause that if wc doesnt pay the claim within  specified timeframe, Medicare will pay but if wc eventually pays, you have to reimburse Medicare.
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Pay_My_Claims

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Re: CAN I BILL WORKERS COMP AND MEDICARE SAME VISIT
« Reply #4 on: December 19, 2009, 09:54:07 AM »
IF A PT HAS WC AND MEDICARE, AND HE IS SEEN FOR HIS WC INJURY, ALONG WITH HTN, DM, HYPERLIPIDEMIA ECT. , CAN I BILL BOTH INSURANCES AS LONG AS THERE ARE 2 DIFFERENT OFFICE NOTES, SINCE HE WAS SEEN FOR ALL OF THESE CONDITIONS???????? ???

He had a good MD, because most MD's that I know won't see you for multiple issues on the same visit

DMK

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Re: CAN I BILL WORKERS COMP AND MEDICARE SAME VISIT
« Reply #5 on: December 21, 2009, 04:35:27 PM »
In California, W/C is very sticky.  It is usually SAFER to schedule a W/C appointment on a different day than the M/C visit, just to avoid a "double billing" situation.  I agree, it's a nice MD who will see the patient all in one!

Pay_My_Claims

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Re: CAN I BILL WORKERS COMP AND MEDICARE SAME VISIT
« Reply #6 on: December 22, 2009, 01:37:17 PM »
In California, W/C is very sticky.  It is usually SAFER to schedule a W/C appointment on a different day than the M/C visit, just to avoid a "double billing" situation.  I agree, it's a nice MD who will see the patient all in one!

Yup, because NC MD's that I know don't do that. When I billed inpatient and outpatient services at the hospital.....it was a NO NO

Michele

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Re: CAN I BILL WORKERS COMP AND MEDICARE SAME VISIT
« Reply #7 on: December 23, 2009, 06:37:21 AM »
Wow, I wouldn't say it is common, but we definitely see it here in NY!
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