Pediatric Care of York, P.C.

Dear Representative of the Revdex.com,As previously outlined by this parent a physician may charge one of four different levels of care for services rendered to children for illnesses ([redacted]). These levels can be based on time or visit components. For a visit to be based on time, the service...

level billed requires at least 50% of the time spent to be for patient counseling. This method is used on less than 5% of services because counseling is not always warranted during a visit.As billing guidelines mandate a provider must bill to the highest level of service provided. Electronic documentation has provided us the ability to value the services by calculating the bullets or components documented during the examination process. These examination bullets are outlined in the Current Procedural Terminology Manual published each calendar year. Apparently the parent is focusing on time which was not how this visit was billed.The billing staff was correct when they refused to accept a settlement" of 125.00. We stand by the documentation, and the medical knowledge of our providers, their integrity, and the fact they treat all patients the same and we bill for services in accordance to federal guidelines. I will be happy to have the collection agency stop pursuing this balance and I will prepare the appropriate [redacted] and file it with the IRS.Pediatric Care of York, PC

Review: We received a bill for my daughters office visit from December 2013. My wife and I originally took my daughter to the [redacted], PA location for congestion, temperature, cough, and what we believed to be at the time, whooping cough. We were in the office a maximum of 25 minutes from check in to check out. She was seen by Dr. [redacted]. The doctor was very brief in observing our daughter. When we asked what the diagnosis was for my daughter, all he said was, that 'she has a cold, not much you can do for it.' He could not have been in the room more than 10 minutes, and acted as if we were wasting his time when I tried to ask a question regarding her care. The code billed was [redacted]. According to my wife's knowledge from being a medical biller for a hand specialist and our CPT book, in order to bill a [redacted] the documentation for this encounter requires TWO out of THREE of the following :

1) Detailed History

2) Detailed Exam

3) Moderate Complexity Medical Decision-Making

Or 25 minutes spent face-to-face with the patient if coding based on time. The appropriate documentation must be included.

In fact, Dr. [redacted] did NOT spend 25 minutes face-to-face with us and our daughter. There was NO detailed examination. I highly doubt she even has a detailed history since at the time of visit she was just shy of 9 months old. Lastly as far as the Moderate complexity for medical decision making is concerned, there was nothing of Moderate complexity regarding our visit, SIMPLE is the best word suited for it. While I appreciate that the Dr. saw our daughter, I do not believe that the visit was coded correctly. My wife and I called the billing office and spoke with several people on several different occasions. Our last interaction with the billing staff, my wife spoke to the manager of the billing department and requested the visit be changed to a more suited code such as for a regular well visit which we always have paid in full in the amount of $125.00. We felt comfortable paying this amount and deemed it appropriate for the services rendered. My wife was told that changing the code would not be possible. She asked if it could be sent back to the doctor for reconsideration and was also told no. I see no reason as to why it could not be sent back for reconsideration, especially when it constitutes fraud if billed incorrectly in my opinion. The billing staff refused the settlement amount of $125.00 that we offered numerous occasions and told us that we could pay the $125.00 but we would still owe the remainder plus any additional late fee's and charges that accrued. They also threatened to no longer see our daughter if we did not pay the bill. Since we do not agree with such bullying behaviors, my wife told them that we were not willing to pay any more than what we deemed appropriate, especially since we do not feel as though the visit was billed even somewhat correctly! So, the billing department manager told my wife that the only other option would be to send our bill to collections, and they did.Desired Settlement: As stated above, we have offered to settle for a lesser amount and we want the code to be re-evaluated and re-billed correctly. The seemingly appropriate code to be billed should be [redacted] depending on medical documentation. We want the collection agency to halt in their pursuit of collecting on this bill, and wish no further contact from them. Lastly, we want the billing staff to be more pleasant, and considerate in trying to settle billing disputes. When the code is re-evaluated and billed correctly, we will pay the bill. We will not pay late fees and other charges that could have been avoided if the billing staff would have wanted to work with us AT ALL,from square one.

Business

Response:

Dear Representative of the Revdex.com,As previously outlined by this parent a physician may charge one of four different levels of care for services rendered to children for illnesses ([redacted]). These levels can be based on time or visit components. For a visit to be based on time, the service level billed requires at least 50% of the time spent to be for patient counseling. This method is used on less than 5% of services because counseling is not always warranted during a visit.As billing guidelines mandate a provider must bill to the highest level of service provided. Electronic documentation has provided us the ability to value the services by calculating the bullets or components documented during the examination process. These examination bullets are outlined in the Current Procedural Terminology Manual published each calendar year. Apparently the parent is focusing on time which was not how this visit was billed.The billing staff was correct when they refused to accept a settlement" of 125.00. We stand by the documentation, and the medical knowledge of our providers, their integrity, and the fact they treat all patients the same and we bill for services in accordance to federal guidelines. I will be happy to have the collection agency stop pursuing this balance and I will prepare the appropriate [redacted] and file it with the IRS.Pediatric Care of York, PC