The Medicare wellness exam is relatively new and can be done yearlyBecause it is not a physical exam but a review of records and preventive measures it can and often is done with a sick visitThese are the rules Medicare allows or we would not be able to bill for it at the same timeDr [redacted] is acutely aware of this and encourages all providers to get the wellness exam done when it is appropriate for each Medicare patient and to do this early in the year if possibleEach insurance company has a contractual agreement with physiciansThere are contractual charges that are adjusted off that you nor the insurance company is not responsible for payingThese are shown on the estimate of benefits statement you get from your insurance company That is the same with the prevnarIt is very expensive for us to purchaseWe do not compare prices with other entities but come up with reasonable and customary charges and the adjustments as well which are approved by the insurance companies through the contractual agreementEvery injection has an injection fee associated with itThat is standard and allowed by the rules set by the medical boardLidocaine mixed with an injection (not a topical rub) is often added to the antibiotics to lessen the painI am sorry they did not tell you before giving you the injectionIt was not done to cause you any grief with billing but to make it less painful at the injection siteEvery provider enters the codes they wish charged for at the visitThe billing office only looks for visits that do not have codes attached and then they must get with the provider to see what they wantthey review records to ensure there is proper documentation to support the codes used for billingThey cannot and do not make up the codesWe have people that are assigned to review charts and ensure the documentation matches the billing codesInsurance companies also do thisThey come to our site and do chart reviewsWe have not had any issues with their reviewsI am very sorry you have issues with the billing
Medicare allows an annual wellness visit yearly which is NOT a physicalIt looks at the preventive measures needed such as immunizations etcfor the 1/31/visit there was no annual wellness visitThere is a note in the chart that says the patient did not wish it to be done and it states do not chargeI do not see in the record where it was billed at this visitAs a matter of reference, Medicare wellness can be done at the same time of a sick visit as it is not, as mentioned, a physical examPrevnar is the pneumonia vaccine that was givenThere are different pneumonia vaccines that are now recommended for patients to havePrevnar is the newest and covers different strains than the regular pneumonia vaccinePrevnar is more expensive, which is not a billing problem but a problem with the cost of pharmaceuticalsLidocaine is given when an antibiotic is given as those injections are very painful so a bit of lidocaine is mixed with the injection to make it be more tolerableThis is common practice but we can make sure and inform patients this has been added for their comfort At SETMA the doctor enters any billing codes they use during the visitThe billing office just complies these and sends to the insurance companyThe billing falls with the provider
? Complaint: I am rejecting this response because: Sincerely, Richard Coward ? Is it usual business practice to charge for both an outpatient office visit and a wellness visit at the same time?? Their response to me sounded like a politician talking in circles and saying nothing.? Their charge for the pneumonia shot was nearly $more than what is charged in other places.? They give me a shot and also charge me for giving me the shot.? The nurse didn't take minutes and they charged $55.? Lidocain is usually used for numbing the site where an injection is to be given.? I am nearly years old and have never had lidoain included in an injection.? As for the doctor's code, I spoke to my doctor about the issue before I left.? I was told who was doing the coding and the charging off.? As? I said in my complaint, it is not the doctor.? I have known him for many years and consider him a friend.? SETMA needs to get its act together, admit that they have messed up, and fix the problem.? Does Larry know about this?
Revdex.com: I have reviewed the response made by the business in reference to complaint ID 12204204, and find that this resolution is satisfactory to me Sincerely, [redacted]
The complaint was reviewedA call was made to Mr [redacted] and an apology was made to himHe was offered to see other providers within SETMA and to chose a different primary care physician that would better fit his needsMr [redacted] responded positively and will be called again this week for follow up to see if he made his decision about another providerThe patient has a contractual agreement with insurance company to pay co paysBy regulations SETMA is obligated to collect copays for office visits when the patient are seenAs of this time we cannot provide credit on the account as the two visit involved being seen by the providerIf the patient would have left before being seen we could refund the copaySETMA CEO has reviewed the complaint and due to confidentiality nature I am not at liberty to discuss what occurred between him and Dr [redacted] however know that this has been discussed and dealt with in an appropriate manner.Submitted by [redacted] ***, RN MSN Director of OperationsSoutheast Texas Medical Associates, LLP
The Medicare wellness exam is relatively new and can be done yearlyBecause it is not a physical exam but a review of records and preventive measures it can and often is done with a sick visitThese are the rules Medicare allows or we would not be able to bill for it at the same timeDr [redacted] is acutely aware of this and encourages all providers to get the wellness exam done when it is appropriate for each Medicare patient and to do this early in the year if possibleEach insurance company has a contractual agreement with physiciansThere are contractual charges that are adjusted off that you nor the insurance company is not responsible for payingThese are shown on the estimate of benefits statement you get from your insurance company That is the same with the prevnarIt is very expensive for us to purchaseWe do not compare prices with other entities but come up with reasonable and customary charges and the adjustments as well which are approved by the insurance companies through the contractual agreementEvery injection has an injection fee associated with itThat is standard and allowed by the rules set by the medical boardLidocaine mixed with an injection (not a topical rub) is often added to the antibiotics to lessen the painI am sorry they did not tell you before giving you the injectionIt was not done to cause you any grief with billing but to make it less painful at the injection siteEvery provider enters the codes they wish charged for at the visitThe billing office only looks for visits that do not have codes attached and then they must get with the provider to see what they wantthey review records to ensure there is proper documentation to support the codes used for billingThey cannot and do not make up the codesWe have people that are assigned to review charts and ensure the documentation matches the billing codesInsurance companies also do thisThey come to our site and do chart reviewsWe have not had any issues with their reviewsI am very sorry you have issues with the billing
Medicare allows an annual wellness visit yearly which is NOT a physicalIt looks at the preventive measures needed such as immunizations etcfor the 1/31/visit there was no annual wellness visitThere is a note in the chart that says the patient did not wish it to be done and it states do not chargeI do not see in the record where it was billed at this visitAs a matter of reference, Medicare wellness can be done at the same time of a sick visit as it is not, as mentioned, a physical examPrevnar is the pneumonia vaccine that was givenThere are different pneumonia vaccines that are now recommended for patients to havePrevnar is the newest and covers different strains than the regular pneumonia vaccinePrevnar is more expensive, which is not a billing problem but a problem with the cost of pharmaceuticalsLidocaine is given when an antibiotic is given as those injections are very painful so a bit of lidocaine is mixed with the injection to make it be more tolerableThis is common practice but we can make sure and inform patients this has been added for their comfort At SETMA the doctor enters any billing codes they use during the visitThe billing office just complies these and sends to the insurance companyThe billing falls with the provider
? Complaint: I am rejecting this response because: Sincerely, Richard Coward ? Is it usual business practice to charge for both an outpatient office visit and a wellness visit at the same time?? Their response to me sounded like a politician talking in circles and saying nothing.? Their charge for the pneumonia shot was nearly $more than what is charged in other places.? They give me a shot and also charge me for giving me the shot.? The nurse didn't take minutes and they charged $55.? Lidocain is usually used for numbing the site where an injection is to be given.? I am nearly years old and have never had lidoain included in an injection.? As for the doctor's code, I spoke to my doctor about the issue before I left.? I was told who was doing the coding and the charging off.? As? I said in my complaint, it is not the doctor.? I have known him for many years and consider him a friend.? SETMA needs to get its act together, admit that they have messed up, and fix the problem.? Does Larry know about this?
Revdex.com: I have reviewed the response made by the business in reference to complaint ID 12204204, and find that this resolution is satisfactory to me Sincerely, [redacted]
The complaint was reviewedA call was made to Mr [redacted] and an apology was made to himHe was offered to see other providers within SETMA and to chose a different primary care physician that would better fit his needsMr [redacted] responded positively and will be called again this week for follow up to see if he made his decision about another providerThe patient has a contractual agreement with insurance company to pay co paysBy regulations SETMA is obligated to collect copays for office visits when the patient are seenAs of this time we cannot provide credit on the account as the two visit involved being seen by the providerIf the patient would have left before being seen we could refund the copaySETMA CEO has reviewed the complaint and due to confidentiality nature I am not at liberty to discuss what occurred between him and Dr [redacted] however know that this has been discussed and dealt with in an appropriate manner.Submitted by [redacted] ***, RN MSN Director of OperationsSoutheast Texas Medical Associates, LLP