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

[Anonymous]

Anonymous wrote:

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.

But then patients get mad when they are double charged for an appointment. Can’t win.

[Anonymous]

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.

Then you are better off using my dh's hack: go give blood and get a blood panel and vitals for free, walk in, no lab fee for blood test AND you get paid!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

But then patients get mad when they are double charged for an appointment. Can’t win.

And patients really REALLY get mad when doctors are running behind because they’re trying to be kind and take care of lots of extra things in the visit. Remember, unless you’re going to a concierge practice or some sweet old School country doctor, decisions about visit times and how many per hour etc are being made by management folks, not clinical staff. It’s truly an impossible situation.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

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.

But then patients get mad when they are double charged for an appointment. Can’t win.

Sigh. Neither the patient nor the insurer can be double charged. That would be billing for 2 visits for the same patient on the same day by the same provider. As has been said numerous times in this thread, that's not allowed.

If it's an evaluation and management visit, you can talk about birth control and discuss anxiety and prescribe blood pressure meds and assess a rash in the same visit and bill it as an upper-level E&M code.

[Anonymous]

Doctors have been complaining a lot about the number of patients they are expected to see in a day and how insane it is. There is also a doctor shortage, because back in the 1980s there was expected to be a huge doctor surplus so things were put in place to start cutting med school admissions and then residencies starting in the 1990s. Eventually this all caught up with everyone. And a lot of doctors are leaving medicine. And yes, some clinics/doctors do limit people to 2 issues per visit.

[Anonymous]

Anonymous wrote:

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.

I don't quite understand this. Wouldn't under-coding mean you're getting MORE services than the doctor is billing for?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:So while we're trying to save the planet and reduce car travel and improve efficiency, the health sector wants us to maximize our use of time and resources.

It's like doing the household laundry by doing a separate load for each sock, shirt or piece of underwear.

May I introduce you to telehealth appointments for acute issues? You may also be interested in combining an in-person urgent care visit in the same car trip with a Target run, then picking up your kid from swim practice. #planet

My acute issues generally require hospital based tests and extensive lab work, not Dr Zoom in Arizona prescribing a Z pack.

They really don't want you doing a telehealth visit in a car, even if you pull over and park.

[Anonymous]

My Dr’s office has signs up making it clear that a physical is no copay but if you address a health issue (ie sprained ankle, throat culture…) that’s not part of the physical there will be a copay for that.

[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.

Then you are better off using my dh's hack: go give blood and get a blood panel and vitals for free, walk in, no lab fee for blood test AND you get paid!

What do they check? Like cholesterol? Anemia Do they give you a print out of the results?

[Anonymous]

Anonymous wrote:So while we're trying to save the planet and reduce car travel and improve efficiency, the health sector wants us to maximize our use of time and resources.

It's like doing the household laundry by doing a separate load for each sock, shirt or piece of underwear.

The idea that the “health sector” cares about the environment is laughable.

[Anonymous]

Anonymous wrote:

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.

Then you are better off using my dh's hack: go give blood and get a blood panel and vitals for free, walk in, no lab fee for blood test AND you get paid!

What do they check? Like cholesterol? Anemia Do they give you a print out of the results?

They’re only concerned about infectious disease when you donate blood, it’s a cute idea but not really of substitute for other labs that may be drawn periodically

[Anonymous]

I remember a time when there was care in healthcare. This systemic “what’s in it for me” culture is unique to the DC area. You may find it elsewhere but not as prevalent.
If you move away you’re in for a pleasant surprise.

[Anonymous]

Anonymous wrote:I remember a time when there was care in healthcare. This systemic “what’s in it for me” culture is unique to the DC area. You may find it elsewhere but not as prevalent.
If you move away you’re in for a pleasant surprise.

I'm not sure I understand what you mean? Can you explain better please?