HealthNet Clarifies Review Policy for Consultations
HealthNet recently notified physicians about onerous new prepayment review requirements intended to "identify miscoded consultations billed in an office setting." According to the notice, claims for consultations (CPT codes 99241 to 99245) performed at the request of another physician must be accompanied by copies of the consultation report and progress notes from the patient's chart. In response to CMA's concerns, HealthNet immediately clarified that documentation would only be required if the patient was evaluated for the same or similar condition within the previous 12 months by the same physician or physician of the same specialty in the same practice. Physicians should receive written clarification from HealthNet within the next couple of weeks.
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