The one thing that billers universally agree on is the struggle of having patients dispute charges performed during their office visits. Most patients do not care that the physician took their time with their examination and was able to arrive at a diagnosis during that visit. The only thing the patient cares about is their high deductible and having to pay it in 30 days or less.
For some of us billers, a phone call is automatically expected while reviewing the claims, we notice that an office visit has been billed in conjunction to a well visit. While this is not unusual in many practices, it then becomes a challenge when doctors do not have documentation to support billing a sick visit with a well. Below are key items to include in your charts to show necessity:
- Patient requests you do additional tests not required or recommended during a well
- Required or recommended tests performed during the well, resulted in further testing needed to be performed by you, your staff or referral to a specialist
- Patient age required specific vaccines, but could not be carried out because of a fever or ailment
- Performing a follow-up from a previous visit that is unrelated to the well visit (can include COVID testing upon request due to exposure)
The above suggestions should ALWAYS constitute an office visit but this is ultimately upon the physician’s discretion.
Following these guidelines will allow your billing staff to properly reiterate to your patients in an educated matter on why they are being billed separately during their well visits. However, it should also be taken into consideration that during a well visit, depending on the age of the patient, certain matters discussed should be part of their visit although the physician may have spent a considerable amount of time on said issue.
Physicians deserve to be reimbursed for their time. However, the overall goal is to not only practice good medicine, but to create an environment and relationship with their patients where they feel open and safe enough to discuss concerns without being billed for it.
Bottom line:
Back up your billing team by documenting appropriately. We are all in this together!
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