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Post by Dave's Not Here Man on Jun 27, 2023 12:00:18 GMT -5
Is my not a doctor doctor really charging Medicaid for an office visit for my online refill requests?
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Post by minx on Jun 27, 2023 12:56:42 GMT -5
Did you actually talk to them? If so, they're allowed.
But if not, WTH?
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Post by minx on Jun 27, 2023 13:39:48 GMT -5
As a side note, when I worked in a doctor's office we spent a LOT of time on prescription refill requests - had to check each individual chart to verify that it was okay to refill, that the refill didn't need to be a written prescription, and that the patient didn't need an office visit. So I don't have a problem with a doctor being allowed to bill for a minor office visit, but it should be less than $30. Because if you don't charge that much, then insurance won't reimburse the true costs.
And that's where the pile of crap comes in. Each company has their 'usual and customary rate' (UCR). And no one lets the doctors or patients see them. So a visit that Aetna reimburses at $50, may be reimbursed $60 by Blue Cross and $40 by United Healthcare. That leaves providers with no option but to charge a ridiculous amount and see what they get back. It's also why they can 'afford' to discount bills for cash patients.
The entire system is fucked.
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Question 1
Jun 27, 2023 13:45:05 GMT -5
via mobile
Post by Dave's Not Here Man on Jun 27, 2023 13:45:05 GMT -5
I need to see my medicaid bills to be sure. The notification I get on mychart is "Office Visit Summary" every time I request refills directly from them via MyChart.
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Question 1
Jun 27, 2023 13:47:48 GMT -5
via mobile
Post by Dave's Not Here Man on Jun 27, 2023 13:47:48 GMT -5
I mean our lawyers would bill for listening to voicemails so I get it that it's still a service being provided. But it's not an office visit and you'd hope there was a code just for managing rx's they call in.
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Post by minx on Jun 28, 2023 15:56:35 GMT -5
I wish, but there's not. So they get billed as something like 'office visit - short'.
There are definitions of each type of office visit in the coding guidelines. Most of them depend on the diagnosis you submit and how many things you've checked. So someone asking for a med refill is at the lowest level. Someone coming in with 20 issues is at the highest. It's been a while since I did that stuff for a living.
The one thing I do remember Medicare doing was abruptly changing the acceptable procedure code. I worked for an allergist, and we'd bill two allergy shots under code xxxxx, and get our money. Suddenly we were only getting half of it - oh, we're supposed to be using code yyyyy instead now. No notice or warning until all of our claims rejected. And we had to submit appeals for all of them - by hand because that was before electronic filing. And did I mention that most insurance companies follow Medicare rules for billing and diagnostic codes. So all of those claims rejected too.
Fun times.
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