Billing tips for group practices and housestaff
By Brett Baker
Q: Can my medical group use a single claim form to bill for services provided to a patient by more than one doctor in the group?
A: No. If another doctor in your medical group sees your patient, the group must fill out a separate claim form for that service.
For each service your group provides, it must list the unique physician identification number (UPIN) of the doctor who actually performed the service in field 24k of HCFA's 1500 form. (This is the standard claim form used by most payers.)
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If a patient was admitted and seen during the week by his or her regular doctor, for example, and then seen again the following Saturday by a different doctor in the group, the group must submit a separate claim for the service by the covering physician. The patient's regular physician can bill for services provided to the patient during the previous week, but not for those provided by the covering member on the weekend.
When several physicians in one group see the same Medicare patient, they must each file a separate claim form.
While it's true that filing claims this way increases your group's administrative load, it is the only correct way to bill for services. Medicare insists that the physician who provides each service be identified on the claim form for the service, even if payment for the service is rendered to the group rather than an individual physician.
Q: I understand that residents and fellows can only bill Medicare if they perform services "unrelated" to their training program (i.e., moonlighting). How does Medicare define the term "unrelated"?
A: Medicare defines "unrelated" as services that are not necessary to fulfill residency or fellowship program requirements. A resident or fellow can moonlight by entering into an agreement to provide coverage for a private physician who treats patients in a hospital outpatient department.
Q: Can residents and fellows bill for services they perform while moonlighting in the facility where they're training?
A: Yes. Residents and fellows can bill Medicare for services they provide in the outpatient and emergency department of their training facility.
HCFA used to prohibit residents and fellows from providing any moonlighting services in their training facility, but the agency changed its policy to comply with a court ruling that specifically allows moonlighting in these settings.
HCFA, however, still prohibits billing for moonlighting services provided in the inpatient setting.
Brett Baker is a third-party payment specialist in the College's Washington Office. If you have questions on third-party payment or coding issues, call him at 202-261-4533, send a fax to 202-835-0441 or send an e-mail to firstname.lastname@example.org.
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