Medical Billing & Medical Coding Blog...

Medical Billing » Blog » Tips to Get Your Consultation Medical Billing Reimbursed

Tips to Get Your Consultation Medical Billing Reimbursed

Tips to Get Your Consultation Medical Billing Reimbursed

Published by: Kathryn Etienne, CCS-P on June 22, 2007

Since consultation requirements have increased in the last year as far as criteria for getting them reimbursed in your medical billing claims, there are some criteria you must be certain that your claims meet in order to justify using codes 99241-99255.

It used to be simple and medical billing consultant merely had to meet the three “R’s” in order to justify medical billing claims for consultations. However the criteria for what does and does not constitute a consultation has changed and in order to make sure that your medical billing claims are paid, you need to reacquaint yourself with the three R’s of medical billing for consultations.

The three R’s are (1) Request for opinion; (2)Rendering of services; and (3) Report to the requesting source. The first big change in late 2006 applied to the qualifying requesters. The new CMS guidelines that were issued now require that a physician make the request. It’s easy to meet this requirement by simply getting a written request; but that’s not all. CMS officials still insist that the requesting physician has to document the request for a consult. The only change is that the consultant doesn’t have to verify that the initiating doctor has done so.

If you don’t have the medical documentation to back up the consultation, chances are good your claim won’t be reimbursed or at the very best only partially so. The best advice you can follow is to let your documentation guide your medical billing and coding. If you can’t meet the three R’s criteria prior to billing, attempt to get the proper documentation to do so, it will mean a little extra leg work, but the practice will reap the rewards in the form of accepted medical billing and reimbursements.

Published by: on June 22, 2007

View all Articles by:

Both comments and pings are currently closed.

Be The First To Comment!

New comments are no longer accepted on this article.

Blog Sections
Blog Archives
Professional Affiliations
Connect With Us
The medical billing blog with billing and coding articles!
Medical Billing & Coding Articles!