Two doctors on the same day

Just recently I noticed that BCBS secondary payor refuses to pay for services for a patient if they've seen another doctor the same day. When a patient is in the hospital, they see lots of doctors on the same day. BCBS is denying these stating they only pay for 1 doctor on any given day. Has anyone had this experience? Medicare isn't doing it so I'm wondering why the commercial plans are (I guess I really know why but hate to think it). Thanks for your answer.

Do you have details?

Who are the docs? Same specialty? Same group? Billing with the same diagnosis? If you were denied, call the other docs and find out what ICD they billed.

Years ago when Gail Wilensky was head of CMS a memo came out that only one doctor should be billing per diagnosis in a day. So if the primary consults endocrine for diabetes, the internist should not bill for Diabetes.

Different doctors/different specialties

Signaturedoc: The patient was in the hospital for a CVA. They were seen by different doctors, different specialties, different practice the same day. They probably used the same diagnosis as well (i.e., maybe an ENT consulted because of swallowing difficulties). I have noticed BCBS doing this only to Medicare patients. I can't call the other docs because I don't know who they are, what they billed, and so on. I'd spend lots of time trying to track down the other doc who consulted on the same day. What do you make of it? Thanks for your answer.

I think

It is what I said- you are both billing the same diagnosis. I did two things to prevent denials- 1- Get my bill in FAST and be the first to use a diagnosis (let the rich specialist get the denial) and -2-if I called a consultant, I did not use their diagnosis. So for the stroke patient, I would bill their hypertension, diabetes, other things I was actively managing to avoid an overlap of diagnoses.

I understand

I understand what you are saying signaturedoc; however, my doc is the specialist. He, like all the other docs involved, are called in either by the ER doc or the PCP who admitted the patient. I'm perplexed as to what to do, other than billing our patients. It's just terrible they're doing that. Our patients are elderly and they don't need another bill. I believe I got these in pretty quick, but I will check and notify the doc for the next time. He gets consults in the hospital all the time but I just noticed BCBS doing this in the last few weeks. They've never seemed to do that before. I just hate BCBS anyway - they are the worst ones to deal with if you ask me. Thanks for your input.

appeal the denials

I think you have to appeal these, with the copies of the hospital visit notes to prove they were medically necessary. You can't just let them be denied.

Then, you have to call the customer service rep and ask why.

And then have your doctor write to the medical director to ask why this new edit is in place.

Editor is right

Appeal these- you were consulted and deserve to be paid. Once again, this is a situation where "it has always been done this way" no longer makes sense in our current health care crisis. Think about it as a taxpayer since we all pay for Medicare- do you want your taxes going to two doctors to treat the same illness? As the specialist, if this continues to happen your doc should give you the referring doc name and you need to coordinate your billing with their billing. Once they call you, they relinquish the right to use that code.

Thanks for the kick in the butt!

You're right - I do need to appeal these and I'm finding them and doing just that. It's such a pain to have to do that because I find with Blue Cross and Blue Shield, nothing really gets settled with them. I appealed one decision they made months ago and they requested the medical records 8 times! 8 times! I finally got so P.O.d, I made a complaint with the insurance commissioner's office and asked the patient to do the same. After they got involved, I got paid but it takes such a bite out of what little time I have to do this job - Anyways, thanks both of you for pointing our alternatives and motivating me to get angry and keep fighting.