“I recently saw a new patient with Oxford insurance for a tinea problem. A prescription was given and options for additional treatments were discussed. We billed his insurance for an initial office visit. The visit was allowed by insurance and the payment was applied to his deductible. He was billed by us. He checked with Oxford and is now telling us that “preventive” care is not subject to the deductible and would like me to resubmit to Oxford telling them that the visit was for “preventive” care. My opinion is that “preventive” care does not really apply to a specialist and that I could not undo what I already submitted. Can we bill for “preventive” care and, if so, is it possible to resubmit the claim?”
by Tahlia Brody, CHP, VP of Customer Service TLD Systems
February 02, 2021
By tahlia@tldsystems.com
0 Comments
in order to be HIPAA Compliant, you must maintain a "Culture of Compliance" at your office. This can include keeping your software up-to-date, regular required training and addressing risks that pose to your office. This month we address Phishing Emails, Battery Backups and Proper Disposal of Copiers/Printers/Fax Machines
Amidst all of the other events in Washington DC in January, a law was passed that amended the HIPAA Regulations. . The amendment requires the department of Health and Human Services to take certain items into account during a HIPAA investigation. The text of the bill reads as follows:
“Based on your experience with the new E/M guidelines, is it possible and appropriate for a podiatrist to bill a level 4 or 5 if the documentation is supported? These higher levels have always been taboo (especially level 5). Some patients are at a higher risk with diabetes, chronic non-healing ulcers and wounds etc. Some patients need amputations. Based on the documentation, I believe achieving these higher levels is possible.”
