Hoping that someone can help ,I recently(2 weeks now) started a new job as a CPC-A. There are many things I need to learn about article 28 facility and I guess how it affects how we bill for certain services. I can’t help but feel that as an article 28 facility same day appt’s would/should be an essential key to the community as well as being able to bill for same as a service provided
Our Providers all work under the same tax ID this includes several Primary Care MD’s, PA’s and NP’s in addition to a Surgeon and Cardiologist All very beneficial services to a rural community as some patients will travel up to an hour for appt’s /procedures.This can be a hardship ,especially for our elderly that often brought to appt’s by their children (who have to miss a day of work in order to help their parents)
I have been told that because we are an article 28 facility and as the Providers work under the same tax ID we just can’t schedule any same day appt’s for specialist and Primary care As well that when a patient is a new patient for the Cardiologist ,Surgeon or PCP we can never use the 99201 -99205 codes Both reasons would cause the claim to be rejected and that only 1 of claims would be paid Even with use of modifier 59
I didn’t ask administration if they were using the newer more descriptive modifier XP as I felt I need to research the use before bringing that subject up, unfortunately I can’t find that needed information
I would love to be able to accommodate our patients better and as well be able to have the Providers reimbursed appropriately If anyone can advise me or direct me to the proper source for the information I would greatly appreciate your help I would have checked the NCCI edits but I believe that comes as a cost which I just can’t afford right now As well I don’t now that that would be specific for the article 28 facility ?? Wondering if well if there is a payer specific caveat
Thank you In advance for any advice, direction in this matter.
Cheri CPC-A
Our Providers all work under the same tax ID this includes several Primary Care MD’s, PA’s and NP’s in addition to a Surgeon and Cardiologist All very beneficial services to a rural community as some patients will travel up to an hour for appt’s /procedures.This can be a hardship ,especially for our elderly that often brought to appt’s by their children (who have to miss a day of work in order to help their parents)
I have been told that because we are an article 28 facility and as the Providers work under the same tax ID we just can’t schedule any same day appt’s for specialist and Primary care As well that when a patient is a new patient for the Cardiologist ,Surgeon or PCP we can never use the 99201 -99205 codes Both reasons would cause the claim to be rejected and that only 1 of claims would be paid Even with use of modifier 59
I didn’t ask administration if they were using the newer more descriptive modifier XP as I felt I need to research the use before bringing that subject up, unfortunately I can’t find that needed information
I would love to be able to accommodate our patients better and as well be able to have the Providers reimbursed appropriately If anyone can advise me or direct me to the proper source for the information I would greatly appreciate your help I would have checked the NCCI edits but I believe that comes as a cost which I just can’t afford right now As well I don’t now that that would be specific for the article 28 facility ?? Wondering if well if there is a payer specific caveat
Thank you In advance for any advice, direction in this matter.
Cheri CPC-A