Coding > Coding

Billing for Home Visits

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Michele:
But if the patients are bedridden then it shouldn't be too difficult to prove it's medical necessary. Unfortunately, sometimes the dr is being 'nice' and they don't get anything for it.

Michele

PMRNC:
If they are bedridden the carrier is going to require prognosis as well to make sure they should not be hospitalized and or/nursing home bound.  One thing you might want to look at is that if the patient is "bed ridden" for how long, and for what? If they are receiving Home Health Care then you probably have your medical necessity right there. It's not likely they are going to approve a house call for someone with the "flu" versus someone who has some sort of disability and cannot get to the doctors, that's where the medical necessity is going to come in. Someone bedridden for the flu isn't going to qualify for payment for an office visit.

midwifebiller:
You can find the definition of POS 11--Office--on the CMS website:

Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.

Depending on your provider type, he/she may routinely provide care outside of a typical office setting and still be able to bill it as POS 11.  We bill for midwives who do most of their work at home. Some have offices, some have a home office and some simply drive from one client's home to another client's home. We bill this care with POS 11.  I have checked with several CPCs and insurance carriers and this has been determined not to be fraud, since this is where the provider routinely provides care.

I agree with what has already been said here about contacting your doc's carriers and finding out what their requirements are regarding home visits (POS 12), especially if he/she is contracted.

~Kelli

Zeecy:

--- Quote from: midwifebiller on August 02, 2009, 03:34:08 AM ---You can find the definition of POS 11--Office--on the CMS website:

Location, other than a hospital, skilled nursing facility (SNF), military treatment facility, community health center, State or local public health clinic, or intermediate care facility (ICF), where the health professional routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.

Depending on your provider type, he/she may routinely provide care outside of a typical office setting and still be able to bill it as POS 11.  We bill for midwives who do most of their work at home. Some have offices, some have a home office and some simply drive from one client's home to another client's home. We bill this care with POS 11.  I have checked with several CPCs and insurance carriers and this has been determined not to be fraud, since this is where the provider routinely provides care.

I agree with what has already been said here about contacting your doc's carriers and finding out what their requirements are regarding home visits (POS 12), especially if he/she is contracted.

~Kelli

--- End quote ---

Thank you Kelli!  That will make life a little easier - I will look into that.

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