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Hospital reimbursement for non-billable services MORE INFO

  • 1.  Hospital reimbursement for non-billable services MORE INFO

    Posted 11-04-2019 14:50
    All,

    Here is another situation that we recently uncovered:

    When a referring doctor (usually the sports medicine doctors) orders exams of the right knee or right foot, the referring doctor also may request an image or two of the corresponding left knee or foot.  However, in this example, only the exams for the right knee or right foot are being charged to the patient on PACS.  

    Unfortunately, when additional images are requested by a physician, then the radiologist is required to interpret those images.  In this example, it seems logical that there would be a exam charged for the left knee or foot. However, we have been told that only the "right" exams can be billed to the patients and insurance companies.


    Please contact me via email or at 417-894-0878 if you have any questions. Thanks and have a wonderful day. 

    Jay Smith, CPA, MBA 
    Executive Director
    Litton & Giddings Radiological Associates, P.C. 
    P.O. Box 14049
    Springfield, MO 65814 

    All information contained in this email is confidential (and may include Protected Health Information - PHI), belonging to the sender who is legally and/or medically privileged. The information is intended only for the use of the recipient named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or taking of any action based on the contents of this email is strictly prohibited. If you have received this email in error, please notify us and destroy the document immediately.


    On Monday, November 4, 2019, 01:43:03 PM CST, Jay Smith <jayradiology@sbcglobal.net> wrote:


    All,

    Here is a list of some of the non-billable exams that our group has encountered.  Change Healthcare is keeping track of them as denials.  

    71010B Chest x-ray post lung biopsy

    71010C  INSTRUMENT COUNT

    71010P  POST PICC LINES

    71010R  POST OP CHEST

    71010T  POST OP THOROCENTESIS

    72020R  CERVICAL, LUMBAR, THORACIC POST OP

    72170R  POST OP REDUCTION

    73020R     POST REDUCTION SHOULDER


    Here is a list of various exams that are not reimbursable unless certain conditions apply:

    EXAM DESCRIPTIONREIMBURSABLE?NEED TO INCLUDE IN DICTATION
    1Post bronch chest x-rayNoThis exam is usually bundled into the surgical  package. The exam is typically for QA or confirmatory films that need to be on file but for the radiologist, there is no reimbursement. 
    2Post-op examsNoThis exam is usually bundled into the surgical  package. The exam is typically for QA or confirmatory films that need to be on file but for the radiologist, there is no reimbursement. 
    3Pre-op chest x-raysMedicare no, some payors yesAlways indicate the patients condition/reason for surgery. Pre-op chests have a better chance at reimbursement if there is a  secondary DX (the reason for the surgery).
    4immediate post op of hearts for instruments / spongesNoThis exam is usually bundled into the surgical  package. The exam is typically for QA or confirmatory films that need to be on file but for the radiologist, there is no reimbursement. 
    5post op abdomens when done for instruments following spine surgeryNoThis exam is usually bundled into the surgical  package. The exam is typically for QA or confirmatory films that need to be on file but for the radiologist, there is no reimbursement. 
    6CXR done after PICC line insertion to confirm position of catheterNoThis exam is usually bundled into the surgical  package. The exam is typically for QA or confirmatory films that need to be on file but for the radiologist, there is no reimbursement. 
    7CXR done after PICC line insertion for conditions not related to PICC line insertionYesIndicate other conditions.  If an unrelated condition arises,  it should be clearly stated so it can be identified as such and not as a baseline for follow up to surgery.
    8Exam for feeding tube (placement or check repositioning)YesIndicate area being viewed (chest or abdomen) and # of views
    9C-Arm fluoro imagesNoThis exam is usually bundled into the surgical  package. The exam is typically for QA or confirmatory films that need to be on file but for the radiologist, there is no reimbursement. 



    Please contact me via email or at 417-894-0878 if you have any questions. Thanks and have a wonderful day. 

    Jay Smith, CPA, MBA 
    Executive Director
    Litton & Giddings Radiological Associates, P.C. 
    P.O. Box 14049
    Springfield, MO 65814 

    All information contained in this email is confidential (and may include Protected Health Information - PHI), belonging to the sender who is legally and/or medically privileged. The information is intended only for the use of the recipient named above. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or taking of any action based on the contents of this email is strictly prohibited. If you have received this email in error, please notify us and destroy the document immediately.


    -------------------------------------------
    Original Message:
    Sent: 10-28-2019 11:10


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