Medicare/DVA Claiming - Referral Override Types

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  • Updated 4 months ago
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As we are a Specialist Practice, our Doctors are able to bill Ultrasound item numbers without a referral, if they determine during or after consultation that the service is necessary.

Medicare allow these item numbers to be claimed without a referral by using the "Self Deemed Code (SD)".  However, this option doesn't appear as a Referral Override Type when submitting through Front Desk, so we are forced to do these manually on our HICAPS terminals.

Is there something that isn't "turned on" in our settings, or is this option just not available in Front Desk.

Thanks
Lisa :)
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SydSportsMed

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Posted 4 months ago

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Timothy, Business Care Manager

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Hi Lisa. To submit these types of claims in Front Desk, follow the instructions below:

1. On the practitioner file, ensure an LSPN number has been added.



2. For the ultrasound item numbers, tick the 'Diagnostic Imaging Service' option.



3. When submitting a Medicare claim, select the '...' icon to access the Additional Information screen and choose 'Self Deemed' from the drop-down menu.




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SydSportsMed

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Thanks :)
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SydSportsMed

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If I am billing it together with a consult item number, do I need to select the '...' icon for both item numbers?
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Andrew, Community Manager

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We believe this is a per-item option to be set only on the diagnostic imaging service. Having said that, Medicare procedures are complicated, and even though we've fully implemented their API we may not be fully across more complex billing situations.

I suggest setting it on the diagnostic code only, and if you need further clarification please contact Medicare on 1800 700 199.
(Edited)