This month, we are delving into a long-standing belief around hospital follow up visits at UTMB, or the “HFU” you might see on your schedule.
At one time, funding existed to cover post-discharge visits for self-pay patients. Language such as "courtesy visit" and legitimate post-procedure billing behaviors have further complicated the issue. However, UTMB’s discharge planning is impacted by the patient’s condition as well as the patient’s financial status. In short, there is no such thing as a "free" hospital follow-up visit.
Patients seen in the Emergency Department or who are admitted as an unscheduled inpatient are discharged with some follow-up instructions that may include clinic appointments as needed. In the case of patients who received invasive treatment during their stay, such as emergency surgery, clinically required follow up care is considered as continuity of care. These patients would be scheduled for post-operative visits with the performing provider in the clinic.
Most surgeries done in the OR carry a global period of 90 days post-operatively. This assumes that routine postop care for the type of surgery done should not extend beyond three months. Although the idea of a global period is mandated by CMS, even a self-pay patient who has an invasive procedure should receive routine postoperative care for the period indicated. This may be where the myth of the free visit was born…as the routine postop care would be at no cost to the patient. These E&M visits would be coded as 99024, ‘post-op’.
It’s important to note that any other billable services such as labs, imaging, or additional procedures would not fall under the global period and would be charged separately, potentially incurring a liability for the patient under their insurance benefits or self-pay rates for these services.
The discharge planning for patients who did not receive any invasive treatments during their stay would not fall under any kind of automatic ‘global’ status. Patients may have been treated and released from the ED with instructions to follow up with their PCP, or with a certain specialty. Inpatients with longer stays may have been consulted on by different providers or services, and discharge planning may indicate the need for follow up appointments with admitting or consulting providers.
In all cases that are not related to uncomplicated E&M visits during a true postoperative global period, charges will be dropped and claims filed for hospital follow up visits. This means that full financial clearance will be required including any required authorizations and patient liability estimates. In some cases, the hospital follow up visits will be considered clinically urgent and will go forward regardless of the patient’s ability to meet their financial liability. These patients will still owe for the HFU visit and will receive a statement for their part of the charges. In other cases, the patient may choose to return to their external PCP, or providers and facilities in their insurance network, for follow-up care.
Hopefully this information helps dispel the myth of free hospital follow-up care at UTMB. For more information or discussion, please reach out to UTMB’s Coding Education team at codinged@UTMB.EDU.
More information about Global Periods Here
Revenue Cycle Financial Clearance working in conjunction with Coding Education to bring you information to manage the patient experience for all patients at UTMB. We are dedicated to the education and success of all UTMB providers. Please contact The RCO Financial Clearance and Coding Education Team to ask questions or schedule a meeting. We are here to help! Email the Coding Education Team. |