Billing Scenario

[HCazarin]

We're an infectious disease office and providers are starting a program for rapid access to HIV treatment.  The initial visit will be to gain access to medication and may only be with the nurse.  In the case of a "new patient" how would we bill this versus the subsequent visit with the provider which would actually be the initial, full medical visit?

[Michele]

If you will be billing that initial visit as a new patient visit then unfortunately you will only be able to code for what is done in that initial visit, which sounds like it would be a lower level code (i.e. 99202), you won't be able to bill for a new patient visit when the doctor does the more involved subsequent visit.  Maybe you want to consider billing the initial visit as the visit with the provider and include the time spent, and components of the initial nurse visit?

[HCazarin]

The visits could be separated by several days.  With our EMR (eCW), our providers do their own coding which is typically based on MDM.  We have considered, but never billed for separate review of records (even though some patients have long, complex histories that require substantial time to review).  Would any of that influence foregoing a charge for the initial visit or being able to include the initial nurse encounter in the later provider encounter?

[Michele]

It is really hard to say without first hand knowledge of each situation.  Based on what you are saying I believe you can wait to include the initial nurse encounter with the later provider encounter.  The concern would be if there is ever a situation where the patient doesn't return?  But then the nurse visit could be billed at that time.

[ace]

Can someone refer me a provider for my medical billing business as i am struggling to get one. Cold calling is not working and i've tried to get around those gate keepers in every way but its just not helping. If someone here has a good script that can get me a provider that would be great.   

[RichardP]

The initial visit will be to gain access to medication and may only be with the nurse.

I'm curious how a new patient is given access to medication - prescription, I presume - without having first been seen by the provider.  Wouldn't that cause problems in an audit?

[Michele]

I thought they meant get list of medications the patient was already taking.  Do the nurses simply gather info?  Or is medication being prescribed?

[Michele]

Can someone refer me a provider for my medical billing business as i am struggling to get one. Cold calling is not working and i've tried to get around those gate keepers in every way but its just not helping. If someone here has a good script that can get me a provider that would be great.   

Getting the first client is definitely the hardest part of starting a MB Business.  We've all been there.  This is where a lot of businesses don't make it.  You have to have drive and not give up. 

• How long have you been trying?
• What methods have you been using?  Strictly cold calling?
• Are you targeting any specialty?
• Do you have any marketing experience, or materials to help you?