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Linda
Brandwin, R.N.
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Linda
Brandwin
is a registered nurse and a medical billing
and claims specialist. For the past 10 years
she has worked directly with insurance companies
to give advice and guidance to the health care
consumer.
Readers may send email
or write Linda Brandwin at 5500 Single Oak Hill
Ct., Woodbridge, VA 22192.
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A
medical claim consists of two compotents
Aug 13, 2004
Q:
I
am a seventy year woman on Medicare. I went to my primary
care doctor for a physical. When I received the bill,
I noticed the doctor had billed Medicare for an office
visit and me for a physical. I understand why I got
billed for a physical but why did he bill Medicare for
an office visit.
A:
The
term "physical" refers to the reason why you
saw your doctor. It is actually more like a diagnosis.
You had an office visit in order to receive your physical
examination or check-up. The office visit is the procedure
by which the doctor performs an examination to evaluate
and manage your health.
A
medical claim consists of two components…a procedure
and diagnosis. Both of these must be present for Medicare
to process the claim. The diagnosis justifies the reason
for the procedure. In your case, you had an office visit
because you needed a physical.
Medicare
may not pay for this office visit if the diagnosis is
for a routine general medical physical. Therefore, if
you signed the proper waiver before your visit stating
that you are aware that Medicare may not cover this
office visit, the doctor's office can send you the bill.
This release is called an Advance Beneficiary Notice.
Read
your Medicare explanation of benefits carefully to determine
what your financial responsibility is. This will be
the only amount you will have to pay.
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