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Question: Lets say it's Monday and you go to your family doctor because you are light headed & complaining of chest pain and he decides to put you on a portable heart monitor with holter and tells you to come back in 3 days. Is it legal for them to bill your insurance daily for a 24 hr hook up (extended daily billing) even though its not yet done? let say they bill the insurance Atena for Monday & Tues and I'm to come in on Wens to have the unit taken off is this legal? I just don't see how they could bill for a test that has not yet completed but they were told they could get the results sent to them on a daily basis from the company and so can bill daily for the 1 hook up. I thought you can't bill daily but was told that they could do it as "extended daily billing" using some type of code so let say for the heart monitor service they bill the insurance $200, but now they say it's $200(per day)x 3(days) for the same hook up which is now $600 for the service.
Hello,
Welcome to Just Answer and thanks for your question. Holter (cardiac event) monitors are billed for whatever time they are worn, whether that is one day or thirty. The bill is submitted to the insurance company the day the monitor is put on, not when it is removed. You (or your insurance company) are paying for the monitoring, transmission of results, and physician review, not just for the "hookup." There are a number of different kinds of monitors and different billing codes, but per day billing at $200 per day is reasonable.
Maybe I'm just not understanding things but what I understand is that the insurance is charged for the hook up and monitoring and that they could bill when it's put on. But what if they are using a code that is for a 24 hour monitor unit and billing each day as a 24hr unit and keep billing for the hook up & interpretation each day how is that right mostly when they only hook up 1 time and do the interpretation 1 time when I come back with the unit. I could see if they are using a code for 3 day or even one for longer but not a code for 24hr one. Are you also saying that there is a system that lets the doctor look at and interprets the report on a daily basis on the same unit so that they could bill for (Hook up & interpretation) daily? is this what is the norm? if so they could also bill it daily for(hook up & interpretation)if I had it on for 30 days right? lets say the "Hook up is $200 and the interpretation is $200" which is $400 a day so for just 1 week it would cost $2800(per week) or if I had it on for 30 days it would cost $11,200 right? I could see charging for hook up 1 time but not each day since I did not go back each day for them to take it off and put it back on.
There are different codes that are used to bill a patient, or the insurance company. Some are for 24 hours, and some are for 30 days, and some are 24 hours times however many days the monitor is to be worn. Some transmit through telephone lines, computers, etc. I would seriously doubt that your doctor's billing office would bill illegally. In the first place, the insurance company would not pay if they had any questions whatsoever. In fact, that is who you really need to contact to make sure that the monitor you are using is exactly what they are charging for. From the amounts I see in my office, $200 per day is quite reasonable. A cardiac even monitor isn't like cable television where you pay for the hookup and then pay for the number of days that you use the service. By the way, there is no billing code for "hookup" of the monitor. The only time that would be coded would be if it were an implantable monitor and then you can charge for both putting it in and taking it out. Unless it is an implantable device, there is nothing to "hook up." There are close to two dozen different billing codes depending on why the monitor is being worn, what type it is, etc. Here is just one company's information on what codes are used. I would suggest that you call your insurance company and discuss your concerns with them.
http://www.aetna.com/cpb/medical/data/1_99/0073.html
Nurse Practitioner
Board Certified Nurse Practitioner, MS, RN. Private practice and hospitalist experience.