Jefferson City Medical Group

On behalf of JCMG, we are responding to the patient complaint, ID # [redacted] .Per CPT code and guidelines which describe the physician patient encounter as an evaluation and management code or more commonly E/M code, a chief complaint is the medically necessary reason for the patient to meet with the physician If there is no chief complaint, the service is preventative and would need to be reported using a code from the Preventative Services Category.When the greater portion of a patient visit is spent addressing a complaint or problem, the focus of the visit is no longer considered to be a wellness exam but rather a problem pertinent visit, even if the patient schedules the visit as a wellness visit.The coding for the services rendered is supported by the physician documentation After review of the documentation by the coding manager, billing staff and physician, it was determined the criteria for a well male examination was not met.While the documentation and care provided during the visit stands as correct, in the spirit of Service Recovery we agree to credit the $copay paid on 12/06/16, thereby creating a credit of $on his account At which time, there are no pending obligations, if this credit remains a refund will be processed

For clarification purposes, in her complaint [redacted] states the date of service was 11/02/16; however, the actual date of service was 11/03/ The importance of this is the insurance timely filing factor[redacted] states she provided the correct insurance information at the time of service, I cannot find any documentation to support this statement The first patient statement for the 11/03/services was generated on 12/30/16, which [redacted] acknowledges she received This patient statement contained a message that stated, "You were not eligible for insurance coverage at the time of service" By the time [redacted] phoned JCMG to notify us she did have insurance coverage it was beyond the timely filing limit designated in her policy Pre-collection letters were mailed to [redacted] on March 17, and March 20, 2017, giving her options to resolve her balance prior to it being placed with a collection agency, she did phone on March 23, asking for additional time to appeal this with her insurance She was given more time as a courtesy and in an effort to resolve this amicably After giving her ample time to make arrangements with JCMG to resolve her balance, it was forwarded to our collection agency.If we had billed this to insurance when [redacted] had requested, her insurance would have denied it for timely, and the same would occur if we billed it at this time It would be best if she would contact the collection agency and make arrangements to pay this balance.Thank you

JCMG Audiologist indicates she has spoken to MrRoberson and is working behind the scenes to resolve the alleged issues involving his ears and hearing aids. Thank you

On behalf of JCMG, we are responding to the patient complaint, ID #[redacted].Per CPT code and guidelines which describe the physician patient encounter as an evaluation and management code or more commonly E/M code, a chief complaint is the medically necessary reason for the patient to meet with the...

physician.  If there is no chief complaint, the service is preventative and would need to be reported using a code from the Preventative Services Category.When the greater portion of a patient visit is spent addressing a complaint or problem, the focus of the visit is no longer considered to be a wellness exam but rather a problem pertinent visit, even if the patient schedules the visit as a wellness visit.The coding for the services rendered is supported by the physician documentation.  After review of the documentation by the coding manager, billing staff and physician, it was determined the criteria for a well male examination was not met.While the documentation and care provided during the visit stands as correct, in the spirit of Service Recovery we agree to credit the $40.00 copay paid on 12/06/16, thereby creating a credit of $40.00 on his account.  At which time, there are no pending obligations, if this credit remains a refund will be processed.

For clarification purposes, in her complaint [redacted] states the date of service was 11/02/16; however, the actual date of service was 11/03/16.   The importance of this is the insurance timely filing factor.[redacted] states she provided the correct insurance...

information at the time of service, I cannot find any documentation to support this statement.   The first patient statement for the 11/03/16 services was generated on 12/30/16, which [redacted] acknowledges she received.   This patient statement contained a message that stated, "You were not eligible for insurance coverage at the time of service".   By the time [redacted] phoned JCMG to notify us she did have insurance coverage it was beyond the timely filing limit designated in her policy.  Pre-collection letters were mailed to [redacted] on March 17, 2017 and March 20, 2017, giving her options to resolve her balance prior to it being placed with a collection agency, she did phone on March 23, 2017 asking for additional time to appeal this with her insurance.   She was given more time as a courtesy and in an effort to resolve this amicably.   After giving her ample time to make arrangements with JCMG to resolve her balance, it was forwarded to our collection agency.If we had billed this to insurance when [redacted] had requested, her insurance would have denied it for timely, and the same would occur if we billed it at this time.   It would be best if she would contact the collection agency and make arrangements to pay this balance.Thank you

Good Afternoon,   Regarding case #[redacted] against JCMG, we phoned the person who made the complaint and left a voicemail for her to return the call so we can answer her question over the phone and we mailed the documentation she requested.   Thank you for your assistance.    ...

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