28 Jun Does your Practice Document Shared/Split Visits Correctly?
One of the main concerns with any medical practice administration is the accurate processing of medical billing and insurance claim forms. This is not only essential for the business accounting, but can also avoid hefty fees and penalties for instances of incorrect processing. There are several frequently occurring events that can alter the required coding and billing processes.
It is imperative that the administrative and billing staffs are aware of these possibilities and know how to handle them individually and independently. This may include the use of advanced technology or customizable software. Complex systems should also utilize some sort of checks and balance system to ensure accuracy and avoid duplicate billing or duplicate claims submission.
To ensure patient satisfaction and the ultimate healthcare experience, many medical care providers utilize midlevel staff members to enhance the office visit. These staff members may include but are not limited to physician assistants, nurse practitioners and non-physician practitioners. These employees or business associates may be on-call for emergencies or to assist with patient backlogs.
This is not only more convenient for patients but is also more effective for the patients but is also more economical for the providers. The efficiency may come at a high price if the medical billing is not done properly. Local, state, and federal regulations may prohibit certain practitioners from submitting claims or collecting co-payments for routine office visits. Additionally, many insurance companies have specific billing practices which may include maximum rates that affect how and by whom patients are seen.
Evaluation and Management
These visits are routine and very common among medical professionals. Patients who receive routine medical treatments or are being treated for a chronic condition that requires regular follow up care are staples to the medical field.
Because there are not usually any major changes to the overall condition of the regular patient, they are typically attended to by a midlevel staff member. There is usually a pattern established for these routine instances. For example, a patient being seen under a pain management treatment plan may see a nurse practitioner regularly, but rather, be seen by their primary care physician on every third visit.
Billing for Split Visits
While the specialization of medical care functions makes the physician partnership or practice operate smoothly on the front end, there are some more complicated measures that must be taken on the billing end. This requires qualified billing and coding employees that have experience with split or shared office visits, especially when it pertains to Medicare or Medicaid patients.
Insurances companies may each have an individual guideline or pay table for services provided by midlevel staff members. In addition, they may also limit the type and frequency of services that are covered when administered by midlevel staff members. In order to submit accurate claims, billing and medical assistants must have a good understanding of these various rules and how to apply them on a case by case basis.
In the instance of federal programs such as Medicare, almost every service that is provided by a midlevel practitioner is submitted for payment at 85 percent of the total cost of service. In cases where a primary care physician submits the same claim, it would likely be paid at 100 percent.
If these office visits are not accurately entered or have not been sufficiently audited, errors could occur that would result in the denial of claims and possibly more serious sanctions. Because the systems may change frequently, medical billers and coding experts need to be aware of where to find the most current information and where to find help in case a question arises.