Does anyone know of documented guidance to support denial of the entire outpatient claim when the only reason for the service was a non-covered procedure (e.g. cosmetic service)? We understand this is an "unwritten rule"; but we see many claims where the non-covered procedure is denied but all other ancillary services occurring on the same DOS are paid. During audit, the entire claim is rejected, and facilities reimburse the entire claim, but we’d like to find a way to stop the claim prior to payment.
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Tag Archives: Ancillary
Chief complaint (carry forward) by ancillary staff
My provider argues that if he is consciously carrying forward Chief Complaint gathered by ancillary staff that he is reviewing it and it should be accepted (without notation).
Would this count as having any validity being that the information was obtained by ancillary staff initially? Shouldn’t there be a notation at least to state that he/she reviewed it for accuracy and that he/she performed it and adding to it if necessary?
Is there anything from CMS aside from the Noridian link (https://med.noridianmedicare.com/web…/clarification) which has more clarification? There is argument that this mainly pertains to HPI and that it is only the HPI that should have a notation for reviewed for accuracy, did perform it and adding to it if necessary. Does this also apply to Chief Complaint?
Can I advise my provider that carrying forward the Chief Complaint is not recommended without notation or he should be documenting the chief complaint himself?
History documented by ancillary staff
CC and History are documented by ancillary staff. I know the provider must document this. Provider has documented comprehensive ROS and PFSH. My question is can an e/m even be charged in this instance? I am doubting myself.
Coding Outpatient ancillary
Hello,
When coding lab for example what types of documentation are you allowed to use to code from??? I have been told that all I can use is the order. I have been told I can use the clinic note. I am really confused as to what is allowed I am new to coding so all the help is appreciated.
thank you
Ancillary fee schedule
Hi There,
Do you know if cardio test performed in the office by cardiologist are paid according to ancillary fee schedule? One of the ins companies requesting a refund as they made an error and overpaid us, instead of processing cardio test according to ancillary fee schedule, they processed per physicians fee schedule-per their letter.
Isn’t ancillary fee schedule for Diagnostic/Radiology clinics? Should this apply to cardiologist?
Thanks
Do you know if cardio test performed in the office by cardiologist are paid according to ancillary fee schedule? One of the ins companies requesting a refund as they made an error and overpaid us, instead of processing cardio test according to ancillary fee schedule, they processed per physicians fee schedule-per their letter.
Isn’t ancillary fee schedule for Diagnostic/Radiology clinics? Should this apply to cardiologist?
Thanks
Ancillary fee schedule vs cardiologists fee schedule
Hi There,
Do you know if cardio test performed in the office by cardiologist are paid according to ancillary fee schedule? One of the ins companies requesting a refund as they made an error and overpaid us, instead of processing cardio test according to ancillary fee schedule, they processed per physicians fee schedule-per their letter.
Isn’t ancillary fee schedule for Diagnostic/Radiology clinics? Should this apply to cardiologist who performed the tests in his office?
Thanks
Do you know if cardio test performed in the office by cardiologist are paid according to ancillary fee schedule? One of the ins companies requesting a refund as they made an error and overpaid us, instead of processing cardio test according to ancillary fee schedule, they processed per physicians fee schedule-per their letter.
Isn’t ancillary fee schedule for Diagnostic/Radiology clinics? Should this apply to cardiologist who performed the tests in his office?
Thanks