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If Blue Diamond is correct, and the claim was denied because it is less than 12 months since the last physical, how is the doc supposed to know that (unless of course it was the same doc that administered the last physical)?
CMS instructions are that if the Dr.'s office or Hospital is not certain of the time frame since the last physical or whatever, they are to ask the beneficiary, call other healthcare providers the beneficiary uses or call the Medicare Admin Contractor (MC) and ask them. They can also acccess the HETS system (HIPAA Eligibilty Transaction System) to get that information.
I was thinking the same thing. Also, some of these preventive exams are every two years unless a person is in a high risk category.
I'm really hoping this woman uses email and you don't have to call her about STD's.
I don't know why ya'll are afraid to have these questions. We have open and candid conversations with our clients about anything we need to. Approach it clinically and matter-of-fact and deal with the issues without getting personal. Changes in tone or voice volume can make one "alert" to this is an uncomfortable area. Just keep the same tone and don't reflect anything other than the facts and leave it alone.
If Blue Diamond is correct, and the claim was denied because it is less than 12 months since the last physical, how is the doc supposed to know that (unless of course it was the same doc that administered the last physical)?
True I see the same doc every year and more if needed. Since the government made electronic records a requirement, he normally (not always) knows when I have seen a specialist and had my diabetic retinal exam. The urology group I see does the electronic records but do not send or hooked up to my doc.
Man speed reading these posts makes for interesting reading I was scratching my head over a diabetic rectal exam