Author Topic: medicare E&M billing question  (Read 1412 times)

MBP

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medicare E&M billing question
« 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..

Michele

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Re: medicare E&M billing question
« Reply #1 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
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MBP

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Re: medicare E&M billing question
« Reply #3 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..

Michele

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Re: medicare E&M billing question
« Reply #4 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
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MBP

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Re: medicare E&M billing question
« Reply #5 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.  >:(

Michele

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Re: medicare E&M billing question
« Reply #6 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
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