APA WF 22-11 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Visit and Sick Visit on the Same Day
The proposed rule changes will update policy to allow payment for both an Early and Periodic Screening, Diagnostic and Treatment (EPSDT) visit and a sick visit on the same date of service when it is deemed medically appropriate.
Please view the circulation document here: APA WF # 22-11 and submit feedback via the comment box below.
Circulation Date: 11/01/2022
Comment Due Date: 11/16/2022
Medical Advisory Committee (MAC) Meeting: 01/10/2023
Board Meeting: 01/18/2023
Comments
James M. Brown:
SoonerCare is the only insurance we deal with that does not allow this. Kids can be treated for an acute issue or for vaccines and well vist, but not both. We often do both and can not/do not charge. It is a burden on patients if we send them away. It also can be a reason for missed vaccines. Really not good for patient or provider and should be fixed.
OHCA Response:
Thank you for your comment. The OHCA takes every comment under advisement and hopes that these changes will be beneficial to both our providers and members.
Aaron P. Wilbanks:
Finally, common sense is being used. We have addressed this issue with SoonerCare previously, including with our previous representative who advised us at the time that we could bill well-child checks and acute care (sick) visits at the same visit. We advised her that was not permissible, despite what her immediate supervisor had told her, and actually pushed a claim through live, so she could see be rejected in live time.
She checked with her supervisors and it went up to chain, until finally she received an email which was forwarded to us in which one of the higher-ups specifically said "We expect doctors to see patients for acute visits in addition to the well child checks without additional remuneration."
My response in writing at the time was that this would be akin to taking your car in for an oil change, and expecting them also to balance and rotator tires for free; or to see an attorney for a lawsuit, then expect them to take care of your divorce for free as well.
Obviously this is not how the real world works, and I'm glad this in her care is finally changing this absurd stipulation that only worsened care for at risk patients.
We literally had to have parent's choose between WCC and shots, or being seen for a sick visit, since we could not do both together. To my knowledge, we have not experienced this with ANY other healthcare plan.
OHCA Response:
Thank you for your comment. The OHCA takes every comment under advisement and hopes that these changes will be beneficial to both our providers and members.
