David,
I need to make a correction above, I meant to say medicare reviewers not auditors. The ones that come in office and review records to make sure the documentation is there to justify the charges submitted.
Also just a few observations. I rarely get any complaints from medicare patients when they receive my office charges for an annual with modifier and 99213. However the 55-64 year old who may have to pay out of pocket, often times the preventative charge is covered and they have to pay out of pocket for a portion of the 99212 or 99213, seems to occur more often compared to the medicare group.
So with ongoing education about what is entailed in an annual versus management of chronic conditions, and how they will be billed, has been helpful to reduce these situations.
We recently met with the head honcho of the Montana exchange/COOP program being instituted, and I am still trying to get up to speed with the platinum, gold, silver and bronze plans, but I think the mindset of patients in these programs will be more akin to the medicare group. I have a feeling there will be less documentation required than with a medicare patient, and less complaints with charges as it occurs in the private sector group currently. I hope any way.
Sorry this is very long winded, but I am likely to participate with the exchange/COOP, and think from a provider perspective, may be a good thing for a small primary care office.
