Are you "allowed" multiple issue at your doctors appointments?

[Anonymous]

My primary doctor takes care of everything at my annual.

[Anonymous]

Anonymous wrote:I would like to know if the providers on this thread talking about "insurance fraud" were born yesterday, or think that we were. Insurance fraud is billing insurers for services that aren't provided, or billing for more intensive services than were provided, or providing and billing for services that aren't necessary. There is no fraud involved with providing additional services during one visit. In fact, insurers almost always prohibit a provider from billing for 2 visits for the same patient in the same day. If the services can reasonably be provided in one visit, the insurer WANTS the provider to do that. And of course that's the case, because requiring the patient to come back another day costs the insurer more money.

No, this penny-ante BS is about providers generating revenues by billing as much as they possibly can. It costs insurers more, but ultimately it costs patients more, in increased premiums and copays. And it's terrible medical care. A good clinician should not be making it as difficult and inconvenient as possible for patients to get the care they need.

That said, PPs are correct that "wellness" visits are not designed for patients' needs. They're mostly an opportunity for providers to collect medical information, which insurers then use to justify raising premiums. At wellness visits, the goal is to hear about and record everything that's wrong with you, not to do anything about it. So if you want an annual check-up, make sure you are making an appointment for one, and not for a "wellness" visit.

1. Under coding is absolutely considered insurance fraud, just like overriding
2. There is no billing difference between an annual check up, a wellness visit, or a preventative care visit. They are all the exact same thing from a billing perspective. It doesn’t matter what you call it.

[Anonymous]

Anonymous wrote:It's been a long time since I went into an office at my last gyno appt we could only discuss one thing like BCP or cramps not both. Insane. They said it was because of billing issues and for each thing I have to come back. Anyway like if you go to a foot doctor for pain, a wart, or a ingrown toe nail do you need 3 appointments? Dermo? A cyst and acne are those two appointments? Primary care IBS and sleep issues two appointments? How are things being handled these days. I need to catch up on things but if I'm going to nee that many appointments I think I'm good. Thank you.

This is 100% insurance driven and you should ask what your insurance will cover. Plus there is not enough time in these appts where your insurance pays the MD $50 to cover 5 issues in 15 min. But in an annual the Doctor can’t screen for health issues to prevent problems and treat at the same time....won’t get paid for by your insurance and not humanly possible for MD with time constraints.

I spend 90 with my new patients for annuals and I still don’t have time to address their multiple chronic issues or concerns. We need another visit for those

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It’s combining an annual wellness visit with a “problem” that is usually the issue.

But it's exactly during wellness visits where they should find or discuss any problems, FFS.
And they are not "free" visits. We all pay dearly in premiums and insurance companies (though sometimes it doesn't feel like it) actually want to find problems before they balloon into big expensive problems. This is exactly what wellness visits are for.

It’s not what wellness visits are for as far as the insurance company is concerned. People really need to understand this. Wellness visits are about preventative care and the components are pretty clearly outlined. That is entirely different than problem visits. It is possible to Join a problem visit to a well person visit ( e.g. You go for your well person/Pap , and mention you think you have a yeast infection and they do that additional exam and offer treatment- hats a preventive care visit plus a 99214 level prob visit.) Please understand medical providers. HATE this coding stuff as much as patients do. But we get it drilled into us that if we don’t code appropriately, it’s insurance fraud that includes in billed “problems“ in the well person visit.

That's absolutely true, from another provider.

And it's not just about us. I would be happy to do something quick in a well visit so that you aren't charged a copay for a sick visit (either added on or as a separate visit) -- but this can be considered insurance fraud by the insurance company.

So why not bill for a well visit and a sick visit? I would rather get charged twice than come twice.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It’s combining an annual wellness visit with a “problem” that is usually the issue.

But it's exactly during wellness visits where they should find or discuss any problems, FFS.
And they are not "free" visits. We all pay dearly in premiums and insurance companies (though sometimes it doesn't feel like it) actually want to find problems before they balloon into big expensive problems. This is exactly what wellness visits are for.

This.

[Anonymous]

Anonymous wrote:

Anonymous wrote:It’s combining an annual wellness visit with a “problem” that is usually the issue.

But it's exactly during wellness visits where they should find or discuss any problems, FFS.
And they are not "free" visits. We all pay dearly in premiums and insurance companies (though sometimes it doesn't feel like it) actually want to find problems before they balloon into big expensive problems. This is exactly what wellness visits are for.

Free? You pay the insurer so complain to them. Your doctor gets almost nothing from them

[Anonymous]

Anonymous wrote:

Anonymous wrote:I would like to know if the providers on this thread talking about "insurance fraud" were born yesterday, or think that we were. Insurance fraud is billing insurers for services that aren't provided, or billing for more intensive services than were provided, or providing and billing for services that aren't necessary. There is no fraud involved with providing additional services during one visit. In fact, insurers almost always prohibit a provider from billing for 2 visits for the same patient in the same day. If the services can reasonably be provided in one visit, the insurer WANTS the provider to do that. And of course that's the case, because requiring the patient to come back another day costs the insurer more money.

No, this penny-ante BS is about providers generating revenues by billing as much as they possibly can. It costs insurers more, but ultimately it costs patients more, in increased premiums and copays. And it's terrible medical care. A good clinician should not be making it as difficult and inconvenient as possible for patients to get the care they need.

That said, PPs are correct that "wellness" visits are not designed for patients' needs. They're mostly an opportunity for providers to collect medical information, which insurers then use to justify raising premiums. At wellness visits, the goal is to hear about and record everything that's wrong with you, not to do anything about it. So if you want an annual check-up, make sure you are making an appointment for one, and not for a "wellness" visit.

1. Under coding is absolutely considered insurance fraud, just like overriding
2. There is no billing difference between an annual check up, a wellness visit, or a preventative care visit. They are all the exact same thing from a billing perspective. It doesn’t matter what you call it.

Avoidance of undercoding is a deliberate billing strategy. It is a letter of law reading of billing rules that deliberately skirts intent. This provides a great example of the phenomenon.

https://www.aapc.com/blog/26957-undercoding-is-no-better-than-overcoding/

"Nothing in the [Medicare fraud] document specifically talks about “down coding” or “under coding,” but if you read between the lines, you’ll recognize under coding as a compliance risk."

Actually, the document doesn't talk about it because Medicare doesn't consider it to be fraud.

[Anonymous]

This is why my son will not become a doctor. BS insurance makes the career a joke.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:If they're related I only need one visit.

What they're trying to stop is someone coming in for the free yearly checkup and then bringing up major issues that needed more time to discuss.

But at a yearly checkup, I got a notice saying I couldn't bring up any problems. It's nuts.

I have an idea of what you should do if you do have a problem: make a (shorter) appointment for that problem. At THAT appointment, for your wart/shortness of breath/rectal bleeding/sexual dysfunction ... do not expect the doctor to peform a breast exam, or order routine cholesterol labs, or offer you preventative vaccinations for shingles or Hep B.

NP. I had a wellness visit and the doctor reviewed my previous chart and then said we can do usual lab work and the mammogram. He did not offer any vaccinations? He just checked my lungs that was it. I thought it was not enough for a wellness visit.

[Anonymous]

It'd an insurance issue. They won't pay for 2 issues, only one

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:It’s combining an annual wellness visit with a “problem” that is usually the issue.

But it's exactly during wellness visits where they should find or discuss any problems, FFS.
And they are not "free" visits. We all pay dearly in premiums and insurance companies (though sometimes it doesn't feel like it) actually want to find problems before they balloon into big expensive problems. This is exactly what wellness visits are for.

It’s not what wellness visits are for as far as the insurance company is concerned. People really need to understand this. Wellness visits are about preventative care and the components are pretty clearly outlined. That is entirely different than problem visits. It is possible to Join a problem visit to a well person visit ( e.g. You go for your well person/Pap , and mention you think you have a yeast infection and they do that additional exam and offer treatment- hats a preventive care visit plus a 99214 level prob visit.) Please understand medical providers. HATE this coding stuff as much as patients do. But we get it drilled into us that if we don’t code appropriately, it’s insurance fraud that includes in billed “problems“ in the well person visit.

That's absolutely true, from another provider.

And it's not just about us. I would be happy to do something quick in a well visit so that you aren't charged a copay for a sick visit (either added on or as a separate visit) -- but this can be considered insurance fraud by the insurance company.

So why not bill for a well visit and a sick visit? I would rather get charged twice than come twice.

Except in specific (rare) circumstances, insurers will not allow a provider to bill for 2 visits in the same day for the same patient.

[Anonymous]

Anonymous wrote:It'd an insurance issue. They won't pay for 2 issues, only one

They won't pay for 2 *visits* to the same provider in the same day. That's not the same as 2 issues.

For non-procedural visits (check-ups, sick visits), clinicians bill for a visit, not for an issue. They bill what are called "evaluation and management" codes. Payment for these codes is based on either the length of the visit or the level of decision-making used. For evaluation and management visits, the reason for the visit is coded to provide evidence that the visit was medically necessary, and that the visit was lengthy or complex. The reason is NOT the basis for payment of evaluation & management visits.

So doctors *absolutely* can code a number of different reasons for a visit on a billing form. When they refuse to do so, it is because they want to bill for more visits. Sometimes that's legit-- they've already spent the time they've allotted for you and need to move on to the next patient. But sometimes it's because they're allotting an unreasonably short period of time to each visit or it's because they are refusing to bundle services together because they make more money by addressing just one of your issues at a time.

[Anonymous]

Anonymous wrote:My primary doctor takes care of everything at my annual.

So they will remove a wart off your foot and/or cut out an ingrown toe nail along with doing a pap?

[Anonymous]

These insane rules are why my physician husband left his group practice and opened his own practice. He refused to not address patient’s needs.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My primary doctor takes care of everything at my annual.

So they will remove a wart off your foot and/or cut out an ingrown toe nail along with doing a pap?

Now that’s not reasonable.