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PowerPoint - Special Visit Premiums & Dermatology - FOR - SLATE - Updated

The document outlines the procedures for billing Special Visit Premiums for on-call doctors, particularly in emergency situations and dermatology. It explains how to use the Special Visit Premium tables from the Schedule of Benefits to determine the correct billing codes and premiums applicable to patient visits. Additionally, it provides examples and activities for practice, emphasizing the importance of accurate billing and the use of specific codes for consultations and surgical procedures in dermatology.

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15 views27 pages

PowerPoint - Special Visit Premiums & Dermatology - FOR - SLATE - Updated

The document outlines the procedures for billing Special Visit Premiums for on-call doctors, particularly in emergency situations and dermatology. It explains how to use the Special Visit Premium tables from the Schedule of Benefits to determine the correct billing codes and premiums applicable to patient visits. Additionally, it provides examples and activities for practice, emphasizing the importance of accurate billing and the use of specific codes for consultations and surgical procedures in dermatology.

Uploaded by

dg6699work
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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OADM29798

Medical E-Billing &


Scheduling
Special Visit Premiums & Dermatology
Special Visit Premiums
• What are they?
• “a visit initiated by a patient or an individual on behalf of the
patient for the purpose of rendering a non-elective service or,
if rendered in the patient's home, a non-elective or elective
service.” (SOB, p. GP65)
• In plain language: When a doctor is “on call,” and is called to
go somewhere to see a patient, premiums may be payable in
addition to the visit fee.
How are on call doctors contacted?

This Photo by Unknown Author is licensed under CC BY

This Photo by Unknown Author is licensed under CC BY-SA


Special Visit Premiums
• How are these premiums billed?
• To determine the correct premiums, use the Special Visit Premium
tables in the Schedule of Benefits (SOB)
• You can find these in the General Preamble, in the “Special Visit
Premiums” subsection.
• The tables start on page GP70 of the SOB
• You can also find the tables by searching the terms “Special Visit
Premiums”
Search “Special Visit
Premiums”

NOTE: You can click


this link in the table of
contents to go directly
to the start of the
Special Visit Premiums
section
Special Visit Premiums
• How to use the tables …
• The SERVICE LOCATION (“Where”) will allow you to locate
the correct table.
• Once you have the correct table, use the TIME AND DATE
(“When”) given to identify the correct column.
• Once you have the correct column, pick the row(s) that best
apply.
• Is this the First patient or additional? Can a Travel
Premium be applied?
Special Visit Premiums
• Example:

Patient seen in the EMERGENCY DEPARTMENT by the on-call


doctor.
First person seen on a Monday at 8:30 AM
Don’t forget to add the
Travel Premium if it is
the FIRST PERSON seen!

Patient seen in the EMERGENCY DEPARTMENT by


the on-call doctor.
First person seen on a Monday at 8:30 AM
Special Visit Premiums
• Example:

Patient seen in the EMERGENCY DEPARTMENT by the on-call


doctor.
First person seen on a Monday at 8:30 AM
K960A, K990A
The travel premium was added because it was the FIRST
PERSON.
You cannot add a travel premium for additional persons unless
the doctor leaves between visits and has to return
Caution!
• There are 2 emergency department tables in the Special Visit
Premium section
• How do we know which one to use?
Which Emergency Department Table should I
use?
• Special visit premium table V - Emergency Department by Emergency
Department Physician is only for use by ER Doctors
• Special Visit Premium Table I – Emergency Department is for all
other doctors.
• We do not have an ER Doctor in YorkMed, so we will always use
Table I when one of our doctors is called in to see patients in the ER.
Special Visit Premiums
• Activity 11-1: Practice Using the Special Visit Premium
Tables
• The tables start on page GP70 of the Schedule of Benefits
• You can also find this section by searching the term “Special
Visit Premiums”
• Take the next 10 - 15 minutes to complete Activity 11-1 & we
will take up the answers when finished…
Check your answers to 11-1
The answer key is posted in SLATE, in the Class folder for this week…
Remember:
Activity 11-2 Dr. Plunkett’s visit codes
are found in:
Consultations & Visits >
• What are premiums? Family Practice &
Practice in General
• They are additional or extra fees.
• What might they be extra or additional to?
• In our case, visits.
• In Activity 11-2, you are working for Dr. Plunkett Again. He is
ON CALL.
• Practice looking up Dr. Plunkett’s visit codes, then applying
additional SPECIAL VISIT PREMIUMS using the table.
Activity 11-2: check your answers
• The answer key is posted in SLATE
• Check your answers, then enter the billing to YorkMed using the dates
indicated on the claims:

NOTE THE SLI CODE:


Use HED – Hospital Emergency
Department if the patient is
seen in the Emergency
Department of the Hospital
Activity 11-2 – Entering Claims to YorkMed
• When you bill these in YMS, the order matters …
1. Bill the VISIT,
2. add the TRAVEL PREMIUM (if applicable)
3. then the FIRST or ADDITIONAL PERSON code.
• NOTE: Travel premiums cannot be added for additional
persons. Only apply a Travel Premium when it says “First
person seen.”
• Also take careful note of the dates and enter to YorkMed
accordingly …
Creating a billing journal for multiple dates
• Instead of choosing one date, select the relevant date range:
Billing Journal for 11-2
Introduction to Dermatology
• Dermatology: the branch of medicine that deals with the
integumentary system (skin and its appendages, including
hair, nails, etc.)
• Visit codes: Consultations & Visits, Dermatology (02)
• Procedures: Integumentary System Surgical Procedures
• Dermatologists are also frequently on-call. This means that
the Special Visit Premiums we learned about earlier may
apply.
• Use the tables the same way as in Activities 11-1 & 11-2
Dermatology
• Other Billing Considerations:
• This is a specialist, so consultations will require a
referring doctor number.
• There is also a note about this doctor’s consultations
…
What does it mean?
• If you are billing a Consultation for our Dermatologist, use A025A
• If you are billing a Consultation for our Dermatologist, and you are
adding Special Visit Premiums to that visit, use A027A
A025A vs A027A
• Example:
• A patient is seen for a Consultation by a Dermatologist during regular
office hours, in the office
• Bill the claim using A025A
• A patient is Patient seen as an emergency in the Emergency
Department – Hospital, first person seen at 7:00 p.m.
• Bill the claim using A027A, and add K0962A (Travel Premium) and K994A (first
person seen)
• A027A, K9062A, K994A
Dermatology – billing tips
• When billing surgical procedures, be on the lookout for the add-on
code E542A
• This is a code that can be added when a procedure is performed
outside of hospital
• It comes up often with Integumentary System Surgical Procedure
billing …
Dermatology HINT: You will need to use the tables
for claims 5 & 6 in the activity

• Activity 11-3
• This activity brings together everything we have learned today
• You will be billing for our Dermatologist, Dr. Chang, and you may
need to apply special visit premiums …
• Complete the activity, check your answers (the answer key is
posted in SLATE, in the class 11 folder)
• Enter the billing to YorkMed using the date of service indicated
on the activity as the date of service and check your work using
the billing journal answer key posted in the class 11 folder
Extra Practice
• Activity 11-4 is posted in the Class 11 folder, along with answer keys
• Complete the activity for homework, before our next class, and check
the answer keys before entering to YorkMed using the date indicated
on the activity as the date of service
• We will take this up next class
For Next Class …

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