Wellness

[granddi]

I know a little bit about medical coding and billing. 

I know a lot about upselling at medical offices. Private pay fees are more than medicare payments.

My new PCP office refuses to code Lipid Panel and CBC with a medical code. They instead code as screening which is automatically denied by traditional medicare. I have talked to the insurance staff with no avail.

I did NOT sign an ABN. This is a new provider and I am not looking forward to a provider divorce over this.  This is so frustrating. I'll probably just pay it and move on. 

[ahoymate]

granddi,

If you do this they will continue handling your lipid, CBC tests as screening.

While I don't know your medical history, I would fight it, talk with the MD, if the MD doesn't help, find another PCP. Yes, I know they are hard to impossible to find. Good luck

[SilleeMee]

My lipid screening and CBC were both part of my annual Medicare wellness visit. I did not have to pay anything extra for those blood tests.

[ahoymate]

I get lipid, CBC tests every 6 mos and no problems with insurance or medicare paying. But I do  have underlying conditions.

[FranandZoe]

Find a new PCP or just don't get bloodwork done.

[DrakesMomma]

Why were the tests done?  According to ICD-10 rules, monitoring a known condition is not considered a screening.  The office staff may not have been able to help because if the doc/provider did not document why the lab was to be done it can't be changed. 

Does the office have a billing service?  If so, reach out to them. 

If you are still responsible for payment see if they will take the amount Medicare would have paid.   

[PickyPicky3]

This is a mistake or fraud. Contact Medicare. Start looking for a new doctor. Don't pay for it. I'm sorry you have to waste your time on this.

[granddi]

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@SilleeMee wrote:

My lipid screening and CBC were both part of my annual Medicare wellness visit. I did not have to pay anything extra for those blood tests.

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Thanks to you all for your responses. This was not an annual wellness exam. I am a heart patient and had some post covid concerns. 

I have had traditional Medicare for 10 years and have never had any issues with blood work or any* other diagnostic testing ever as ordered by my physician--until this new provider! They are either doing this deliberately or do not know how to code. I agree the insurance clerks are just processing what is given to them and yes, they do outsource billing. So it is an issue to discuss with doc. But I see no future in this arrangement. 

(*  a Calcium Cardio Score and this is NOT a medicare covered test)

[chrystaltree]

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@granddi wrote:

I know a little bit about medical coding and billing. 

I know a lot about upselling at medical offices. Private pay fees are more than medicare payments.

My new PCP office refuses to code Lipid Panel and CBC with a medical code. They instead code as screening which is automatically denied by traditional medicare. I have talked to the insurance staff with no avail.

I did NOT sign an ABN. This is a new provider and I am not looking forward to a provider divorce over this.  This is so frustrating. I'll probably just pay it and move on. 

It appears, you know little to nothing about medical coding and billing.  If you went to the doctor with specific symptoms or complaints that support the labs they ordered, Medicare would pay because they would use the medical diagnosis codes.  If you had already been diagnosed with a condition that supported the labs, they would use the appropriate diagnosis codes.  If it's just a routine physical with this new doctor,  then a screening code is appropriate.  They won't provide a false diagnosis codes just to get paid.  That's illegal.  

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[sann]

I had yearly lab work last month...all expenses were paid in full by Medicare ..something about this doesn't sound right..