January 30, 2019
Area(s) of Interest: Patient Care Payor Issues and Reimbursement Practice Management
CPR’s “Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care.
Potential patients sometimes ask to meet with a provider prior to needing health care to be sure that the patient/provider relationship will be a good fit. For example, it’s common for expectant parents to “interview” obstetricians and pediatricians.
The reality is, time equals money, and physicians’ time is in demand. As such, practices may wonder if it’s possible to bill for such meet and greet visits. The answer is yes, but you probably won’t want to.
Without Medical Necessity, Insurers Won’t Pay
To be clear, you shouldn’t bill a meet and greet visit to a patient’s insurer.
Insurers, including government payors such as Medicare and Medicaid, reimburse only those services or procedures that they deem to be medically necessary—and a meet and greet doesn’t meet the definition. The individual meeting with the provider may be a potential patient, but if there’s no medical reason for the visit, the insurer isn’t going to treat the claim as legitimate.
You cannot report evaluation and management (E/M) service codes for a meet and greet because E/M services require a chief complaint, defined by CPT® as “a concise statement describing the symptom, problem, condition, diagnosis, or other factor that is the reason for the encounter, usually stated in the patient’s words.” Again, if there’s no medical reason for the visit, there’s no medical care to report.
Preventive services don’t require a chief complaint, insurers often reimburse for them, and CPT® designates a subsection of E/M codes to report them. But, a meet and greet visit won’t include the age and gender appropriate history, examination, counseling, anticipatory guidance and other required components of a preventive service.
ICD-10 does provide codes to describe meet and greet visits, for instance, Z76.81 Expectant parent(s) prebirth pediatrician visit. ICD-10 is a very thorough code set to allow for precise, wide-ranging data collection, but the existence of an ICD-10 code has no connection to medical necessity and doesn’t guarantee payment.
The bottom line is this: Billing any type of E/M service code for meet and greet visits is inappropriate, potentially abusive and fraudulent.
Billing the Patient for “Non-Medical” Services
Just because you provide a non-medical service doesn’t mean you can’t bill for it. For example, offices routinely charge for services such as filling out forms—for schools, sports, life insurance, medical leave, etc.—that are not connected to a patient visit, or for copies of medical records (states typically regulate how much you may charge to copy medical records).
Similarly, you could charge patients directly for meet and greet sessions. Before doing so, however, there are a few things to consider.
First, you have to acknowledge that charging for a physician meet and greet might turn off potential patients before you even get them in the door. Providers benefit from positive relationships with their patients, which makes charging for meet-and-greet style visits an especially difficult proposition.
Second, if you decide that charging for a meet and greet is worth the effort, you should be sure to establish a written policy, alert potential patients to it ahead of time, and follow it consistently. Patients should know how much they will be charged, and how and when they should pay (unless you collect “up front,” you’re unlikely to collect, ever). You should be clear that insurance won’t cover the service, and that you will not file a claim on their behalf.
Note: The above information does not constitute, and is not a substitute for, legal or other professional advice. Readers should consult their own legal and other professional advisors as necessary for individualized guidance with respect to each particular situation.
Save the Date for AAPC’s HEALTHCON 2019, April 28 to May 1
AAPC, a training and credentialing association for the business side of health care, is hosting its 26th annual HEALTHCON on April 28 to May 1, 2019, in Las Vegas, Nevada. The conference is geared toward all levels of medical practice leadership and will offer attendees a multitude of tools and resources to help guide them to success, including:
- Over 120 educational sessions featuring the industry’s hottest topics, including a presentation by Karen DeSalvo, M.D., President Obama’s Acting Assistant Secretary for Health.
- 3,000 health care professionals to network with.
- More than 75 exhibitors for a chance to learn about the latest products and services in the industry.
For more information or to register, click here.
AAPC has long been the California Medical Association’s (CMA) partner in billing and coding education, providing CMA’s monthly “Coding Corner” column and offering key education for the ICD-10 transition.