[Ohioaap-practicemanagers] Reimbursement for simultaneous "well visits + acute" clinic visits

[Michele Dritz]

I recently found out from our billing department that whenever we have a
patient encounter that we’ve billed as both a “well visit + an acute (or
follow-up) visit” using a modifier 25 (assuming it meets the criteria of
both), that the reimbursement ends up amounting to approximately:
the entire “well visit” reimbursement + ~50% of what would have been the
“acute or follow-up“ visit (regardless of level coded)

That is in contrast to receiving the full reimbursement if we have the
patient/family come back for a separate visit to take care of either
component of the care (the well visit or the acute issue), rather than
taking care of all of the things the day they are in clinic.  This is
particularly challenging as we attempt to better address the needs of our
adolescent population who we already know aren’t coming to clinic very
often, so we are often trying to address multiple things simultaneously to
make the most of every encounter.

I would be interested in hearing if others have OR have not found this same
issue.  Do you see a difference in practice between your Medicaid versus
Private insurers? Is there any other pattern you have noticed when you give
this type of care & bill appropriately?

Thank you ahead of time for your input & time!

Michele Dritz, MD
Dayton, OH

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Michele Dritz
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