What is a Preventive Exam? 

Preventive exams are routine examinations that include a general physical exam and a discussion regarding healthy lifestyle changes, preventive screenings, updating medical and family history, immunizations as well as screening for suspected conditions as necessary (bone density, EKG's, labs, mammograms). 

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What you need to know:

Any testing (EKG, lab work, etc.) that is ordered by the physician, in addition to the routine screening and exam, will be billed with the appropriate diagnosis code for the existing condition. A diagnosis code cannot be changed in order to remove or change the deductible or balance due to the invoice. 

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Prescriptions written for chronic conditions are not deemed a routine service. 

 

Please be aware that some insurance plans do not pay for testing that is not considered routine and the balance will be patient responsibility. 

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What is Split Billing? 

In some instances, a preventive exam is performed and there are other medical conditions that are managed during the same visit. This will result in billing for a preventive visit and an office visit at the same time. In this case, the patient/guarantor will be responsible for any co-pay and/or deductible charges related to the office visit. These are guidelines set forth from both government and insurance payers. 

 

What you need to know: 

Split billing occurs if the patient needs to address conditions/medical issues in addition to the preventive visit mentioned above. 

 

Insurance plans vary greatly; our office is not able to determine each carrier's specific coverage for these visits. The patient is responsible for knowing their insurance package details and in turn are responsible for outstanding balances that are not covered by insurance.