Coding > Coding
Billing for Home Visits
Zeecy:
I have a few questions about this.
It seems, after some research, that the only differences between billing for an office visit and a home care visit are the POS (21 instead of 11), and the visit codes (99341-99350). Does anyone know of anything else I need to be doing?
I did come across a topic on this site where it seems that at least for Medicare (& other insurances too?) I have to be able to provide proof of medical necessity. What if there isn't medical necessity but the physician is just a nice guy who doesn't mind doing house calls? Or it's a way to obtain a larger patient base? Is it not worth it then? Would we not get paid for the house calls? Should they be billed as regular office visits in that case, or is that dishonest?
Also, does anyone know how the reimbursement compares to home visits, or where I might look that up?
Thanks in advance!
PMRNC:
--- Quote ---I did come across a topic on this site where it seems that at least for Medicare (& other insurances too?) I have to be able to provide proof of medical necessity. What if there isn't medical necessity but the physician is just a nice guy who doesn't mind doing house calls? Or it's a way to obtain a larger patient base? Is it not worth it then? Would we not get paid for the house calls? Should they be billed as regular office visits in that case, or is that dishonest?
--- End quote ---
It wouldn't only be dishonest it would be "fraud" You cannot change a procedure, POS, or code to obtain reimbursement or higher reimbursement, you must report what was done and use the correct POS. If there is no medical necessity than the claims will not get paid. If it is a physician just being a nice guy (remember nice guys finish last) then he might have to rethink offering this service unless there is a medical necessity to support the house call.
Michele:
--- Quote from: Zeecy on July 21, 2009, 05:43:19 PM ---
It seems, after some research, that the only differences between billing for an office visit and a home care visit are the POS (21 instead of 11), and the visit codes (99341-99350). Does anyone know of anything else I need to be doing?
--- End quote ---
That is pretty much the difference.
Linda is right, if the dr sees the patient in the home, it would be fraud to bill it as an office visit.
Michele
Zeecy:
Yikes. I don't want to commit fraud! I just thought that if the insurances weren't willing to pay extra for a house call, they might be willing to just pay for the visit as if it was in the office which I assumed was a lesser amount, which I also assume is the reason they don't want to pay for house calls. Sorry for that confusing run-on - I just wanted to clarify. Anyway, it would be for bedridden patients, I just don't know how to prove that yet.
Nice guys DO finish last, don't they...
Does anyone know if we need pre-approval then for home visits? I mean, what if they don't like what we consider medical necessity?
PMRNC:
You will need to contact the carrier to find out what their requirements are to establish medical necessity.
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