Billing Based on Time

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Joined: Wed Apr 12, 2017 9:45 am

Tue Nov 22, 2022 8:34 am

I am looking for guidance on a provider who is billing everything based on time and has a higher utilization of level 99215s. His documentation based on MDM only supports the 99214 level but his time documentation supports the 99215. We have looked at his time for the day based on CMS time per procedure and it is about 8- 11 hours per day total. We know Medical Necessity is still required however if the provider documents they spent 50 minutes with the patient reviewing prior records, documenting in the chart, etc. it is hard to use medical necessity as to why they can’t be billing all based on time. Does anyone have any advice on how we could handle this type of situation?
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