Sara wrote to tell me about a Medicare Advantage patient with a lobar pneumonia seen on an x-ray at an outside Urgent Care. The patient was diagnosed with an unspecified pneumonia.
Unspecified pneumonia has no additional compensation. Lobar pneumonia does.
She is being comped under a partial-risk contract. How can she make sure that the lobar pneumonia code gets submitted?
I advised her to get the patient in for a follow-up and do it then. After all, she’s going to need a follow up x-ray.
But what if the patient refuses to come in? Or doesn’t keep her appointment?
Offer to do a house call.
Is it worth it?
If the base capitation for that patient is $1000, a lobar pneumonia code could increase that capitation by 20% for 12 months.
That’s $2400 gross.
Sarah’s on a partial-risk contract, so she won’t see all that.
But under the worst such contracts I’ve seen, she should net at least $500 over that 12 months—all for one house call.
So, heck yes—it’s worth it.
House calls are now important tools to make sure you collect risk codes for episodic illnesses that you might otherwise miss.
Use it and set yourself apart