NARHC Forum
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| 7/13/2020 @ 11:22:00 AM
Post 1 of 4
Contributor: Sherri Johnson, McPherson Medical & Surgical Associates
We are just starting to bill for RHC. In our training we heard something about the medication injected (i.e. Prolia) can be billed with or linked somehow to an E/M face to face visit within 30 days, Why is this beneficial? How do we link it? Does the medication need to be moved from one account to the account with the E/M level visit on it? All this is very confusing and any guidance would be appreciated. 7/13/2020 @ 11:34:00 AM
Post 2 of 4
Contributor: Patty Harper, InQuiseek Consulting
Any incident-to service can be reported with an E & M within 30 days. It is a difficult thing to handle administratively. All services are reported on the date of the E & M since the RHC bill cannot have a date span. You are correct. It will still only result in the payment of one AIR. In the case of Prolia injections, the cost of the drug will be included in your allowable costs in your rate calculation. However, at the normal 60 mg dose, you will not receive complete reimbursement on a case by case basis. This is a big concern for systems which are now looping rheumatology into the RHC. Perhaps these injections could be given in another clinic or outpatient setting if this is a problem for you.
Patty Harper, RHIA, CHTS-IM, CHTS-PW, CHCR Healthcare Consultant/Principal 318-243-2687 (Cell) 866-855-0683 (Fax) 940 Ratcliff Street Shreveport, LA 71104 The information contained in this transmission may contain privileged and/or confidential information, including patient information protected by federal and state privacy laws. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified that any review, dissemination, distribution, or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message. 8/4/2020 @ 11:23:00 AM
Post 3 of 4
Contributor: Sherri Johnson, McPherson Medical & Surgical Associates
Needing further clarification on the injection w/I 30 days of E/M visit. We had someone tell us the 30 days rule was that it had to be within the same calendar month of the E/M visit. For example, E/M visit was done on 7/15/20 and Prolia was given 8/1/20, we can't bill the Prolia injection with that E/M level because the Prolia wasn't given in the same calendar month as the E/M level. Is that correct?
8/4/2020 @ 11:28:00 AM
Post 4 of 4
Contributor: Sherri Johnson, McPherson Medical & Surgical Associates
Needing further clarification on the injection w/I 30 days of E/M visit. We had someone tell us the 30 days rule was that it had to be within the same calendar month of the E/M visit. For example, E/M visit was done on 7/15/20 and Prolia was given 8/1/20, we can't bill the Prolia injection with that E/M level because the Prolia wasn't given in the same calendar month as the E/M level. Is that correct?
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