Not many understand and fully appreciate the necessity of getting the consultation code absolutely right.
Regardless of which insurance company you are sending an invoice to, the correct codes are:
INITIAL consultation = 20300
FOLLOW UP consultation = 20310
But why is this so absolutely necessary?
Because the code used will dictate the amount that will you will be paid.
So do NOT get them the wrong way round!
Let me illustrate this with a real example. MHM was called in the examine and review the billing process used by a consultant surgeon recently. The major item of concern to be identified was the use of the wrong code for initial consultations. More specifically, the code for the follow-up was, in error, being used for initial consultations instead.
What appeared to be a small error actually had negative financial implications.
The consultant was charging £125 for an initial consultation and £100 for a follow-up consultation. During July he had undertaken 13 initial consultations which should have generated £1,625. But by using the code for follow-up consultations of 20310 instead of the initial consultation code 20300 he had actually only invoiced for £1,300 and was, therefore, £325 out of pocket.
Whilst the majority of invoices had been sent to private insurance companies – who had paid the lower rate – some were for self-funding patients. They too had paid the lower amount. In both events, it was extremely difficult to re-submit the invoice for the higher amount. For one thing the consultant was too embarrassed to ask the private patients anyway.
So whilst it was not possible to correct previous errors, it is very clear such errors must be stopped as soon as possible.
One of the primary areas MHM is asked to examine is whether or not the private consultant is actually charging what they should for their work.
Surprisingly and as will be illustrated this week, many are not!