decisionhealth Newsletters, Part B News - 2014 Issue 6 (June)
Charge patients correctly when billable, non-covered services done for same visit
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Article Overview
This article is aimed at coders, billers, and compliance staff who need to understand how Medicare payment and patient responsibility are handled when covered and non-covered services occur on the same date. It covers the general carve-out approach, how charges are separated for billing purposes, when advance notice issues arise, and documentation considerations for combining a problem-focused visit with preventive services.
Why This Topic Matters
Incorrect handling of same-day covered and non-covered services can affect patient billing accuracy and the Medicare claim. The article helps readers understand the broader billing workflow and documentation concerns involved in these encounters.
Article Sections
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Carve-out basics for same-day covered and non-covered services
Introduces the general billing scenario involving preventive and covered services on the same date. Explains the purpose of separating charges and why accurate patient responsibility matters.
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Examples of mixed preventive and covered visits
Describes common encounter types that can trigger the billing issue, including routine preventive services paired with problem-oriented care. Mentions general considerations that may affect how the visit is handled.
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Counting systems and exam elements
Summarizes documentation and encounter-structuring considerations when preventive and medically necessary services occur together. Addresses how visit components are separated for coding support.
What You Will Learn
- How same-day covered and non-covered services are generally separated for billing purposes
- Why actual charges matter in calculating patient responsibility
- What documentation issues can arise when preventive and problem-oriented care occur together
- How preventive service encounters may be distinguished from medically necessary problem-focused visits
- What general Medicare-related considerations affect these mixed encounters
Who Should Read This
- Medical coders
- Medical billers
- Compliance auditors
- Revenue cycle staff
- Physician office staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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