Services "Just Outside" Global Follow-Up Periods

[pattil88]

Has anyone had any issues with payers "screening" for dates of service which occur just outside the global follow-up period for surgery?  For example, a patient had surgery on 9-1-10 and the global follow-up for the procedure is 90 days (covering post-op care during Sept, Oct, and Nov) then the patient presents again in early December (just outside of the 90 day follow-up period) for another visit related to the surgery. The physician wants to bill for that visit since it is technically "outside" the post-op period. I get a little nervous when I see visits like this starting to get scheduled on a "routine" basis - any thoughts?

[Michele]

Well, if all of the provider's surgery patients seem to need to be seen right after the end of the global period that does sound fishy.  It will of course happen, but not on every patient.  If he is thinking that this is a good way to increase reimbursement I would strongly disagree.  It's a good way to get booted from insurance plans at the very least.  I personally as a patient would find it suspicious if my dr wanted to see me regarding my surgery, but advised me it was outside the global period so I would need to make a copay.   

[PMRNC]

I can answer this but only from a claims adjuster's stance.. If receiving a claim for a follow-up, claim check would bring up surgical/procedural related to follow up and all visits within global period. IF i were to get this claim and it was JUST outside the global period, I would definitely pend claim and request chart notes/explanation.. SOMETIMES a patient cannot meet their appt within the global time period....What would definitely raise a red flag for me is the frequency this is happening, it SHOULD NOT be a "routine" thing.