Expect private payer problems after Medicare eliminates consults

Why This Topic Matters

Practices need to adjust billing workflows before the Medicare change takes effect so they can avoid claim denials, inconsistent payer handling, and revenue disruption when consultation services are involved.

Article Sections

1. Medicare consultation billing change

   Introduces the Medicare policy change affecting consultation billing and the need for practices to prepare before the effective date.

2. Billing policy considerations for private payers

   Discusses how practices may want to handle consultation services under different payer arrangements and the importance of establishing a consistent office policy.

3. Examples of possible claim denials

   Describes the kinds of payer denials offices may begin to see after the change and the need to review, correct, or appeal claims as appropriate.

4. Medicaid and state-specific variation

   Notes that Medicaid consult-related rules may differ by state and should not be assumed to match Medicare policy.