here we go again, Humana being picky picky picky about paying our claims.
Procedure code 99497 pays for up to 30 minutes of discussion and completion of the Advance Care document.
If the document is in the patient's record, it's pretty obvious that SOME time was spent. It's also obvious that it was less than 30 minutes due to the procedure code used.
The fact that Humana is applying this rule so stringently is discouraging us from offering this service to our Humana patients.
Do you think a patient likes knowing a provider is timing their visit? Do you really think this leads to trust in a provider when a patient feels like they're taking up too much of the provider's time?
Wouldn't it be nice FOR A CHANGE that Humana respect our ability to give our patients the best care we can? Or is it down to minutes and seconds. Look, we could spend 29 minutes on the ACP and do a horrible job of it. And they'd pay us for it. So this is ridiculous.
CMS suggests that if an ACP takes less than 16 minutes, the provider should bill an E/M code instead. The problem with this is, the CPT for the ACP won't show that it was done and Humana will dock us for not doing them.
We are begging our patients to enroll in Medicare and get out of the for-profit insurance market. This is what happens when an insurer is worried about their CEO being able to afford a new yacht. I've never had an ACP denied because time wasn't documented by CMS. Documenting time does not contribute to a patient's wellness.
Apparently Humana cares more about a ticking clock than they do knowing a patient is getting good care. It's that simple.
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