decisionhealth Newsletters, Answer Books - 2009 Issue 9 (September)
Consults, Visits, Referrals / Second and Third Opinions
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Article Overview
This premium article addresses Medicare payment policy for second and third opinions, including when these opinions are considered covered in relation to surgery or major procedures, and how the service is distinguished from a referral or change of physician. It is useful for coders, billers, and compliance staff who need a general understanding of Medicare consultation-related guidance and claim submission context.
Why This Topic Matters
Understanding how Medicare treats second and third opinions helps billing and compliance teams evaluate whether a consultation scenario is likely to be covered and how it is generally distinguished from other visit types.
What You Will Learn
- How Medicare approaches second and third opinions in consultation scenarios.
- What general circumstances are associated with coverage consideration for these services.
- How second and third opinions are distinguished from referrals or a simple change of doctors.
- What high-level claim context the article addresses for these situations.
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Practice managers
- Physician office staff
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