Note: This article contains information that is only relevant to American clinics.
If you ever find yourself wondering about the right time to bill an insurance provider for a re-evaluation, rest assured that you aren’t the only one. You might be inclined to think that you should bill them after you’ve re-certified a Medicare patient, or on the same day that you reported on functional limitations and G-codes–but, doing so can cause your claim being denied.
A recent article from our friend Rick Gawenda of Gawenda Seminars & Consulting informed us that “the simple answer is no, a re-evaluation is not appropriate to bill for the sole purpose of writing a progress report, doing a Medicare re-certification, and/or reporting functional limitation G-codes.”
Rick then went on to tell us about the most appropriate times to bill an insurance carrier, including the Medicare program, for a re-evaluation. They are as follows:
So, if you’re ever in doubt about whether or not you should be billing your patients’ insurance providers for a re-evaluation, or if you’ve had these types of claims denied in the past, do your best to remember the above criteria.
And at the end of the article, Rick raised a question; how do you account for time spent gathering subjective and objective data to writing a progress report, or completing a Medicare recertification? The answer to that question and more can be found on the Gawenda Seminars & Consulting website.