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Special Update



Medicare’s New Process For Consultation Services


Medicare is continuing to provide updated guidance on how to submit consultation services using the approved Evaluation and Management codes for dates of service for January 1, 2010 and beyond.  Medicare hosted a conference call on January 6, 2010 that further reviewed the new process and answered questions from providers and staff.  A recording of the conference call, “Teleconference: Consultation Services” is available for auto replay on Medicare’s website for the 5 days following the original call.  A link to Medicare’s web site is below.

Alta Partners strongly encourages it clients to listen to the conference call and become aware of the changes.  These changes are affecting all providers (Primary Care and Specialists).  The discussion about the elimination of consultation codes by Medicare became heated during the second half of the conference call because it will affect Medicare Secondary Payments (MSP).  Since this change is not being recognized by all commercial payers, some commercial payers will be billed the consultation code.  The consultation code then needs to be converted to an approved E&M code for secondary processing my Medicare.  Medicare is advising providers to either convert the code as identified above or bill the commercial payer the approved Medicare E&M code.  Both options will potentially create unnecessary denials for the provider. If the second option is followed, some commercial payers may deny the claim as duplicate since it is possible that two providers will bill the same E&M code on the same date of service for a patient.

For inpatient services only, physicians who are the admitting doctor will now have to use a modifier A-1 to identify that they are the admitting doctor and the specialist will use the appropriate inpatient visit code.  This is another area of controversy and confusion, but Medicare is moving ahead with all of these changes despite the outcry.  We will continue to keep you alert of changes as developments occur.

Alta Partners is currently developing a key billing change reference sheet that can be used to assist our clients with this transition.  If you have any questions about the new Medicare billing process for consultation services, you can contact your accounts receivable representative or Jeff Kovacs (440) 808-3694 for additional information.