decisionhealth Newsletters, Coder Pink Sheets - 2012 Issue 7 (July)
Don’t miss billing consultation services to payers that still cover them
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Article Overview
This article addresses billing consultation services across payer types, with emphasis on situations where commercial plans may still recognize consult services even though Medicare does not. It is aimed at clinicians, coders, and billing staff who need to understand the general documentation, referral, and reporting practices discussed in the article so they can determine whether the premium guidance applies to their claims workflow.
Why This Topic Matters
The piece helps practices avoid overlooking payable consultation services and supports a more consistent front-end review of payer policy and documentation. It is relevant for offices that handle outpatient consult workflows and need to distinguish consult services from referrals in a payer-specific environment.
What You Will Learn
- How consultation services may differ across Medicare and non-Medicare payer policies
- What broad documentation elements are discussed for consultation billing workflows
- How practices can review referrals, requests, and reports in a consult process
- Why payer-specific verification matters before submitting consultation claims
Who Should Read This
- Physicians
- Coders
- Billing staff
- Compliance staff
- Practice managers
Codes Discussed
Code Ranges Discussed
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