Sandra Cunningham, Director of Billing
Tyler CVC, Tyler, TX
Answer: The answer to that question is a sensitive one, sources tell us. The problem is that Medicare will only pay for one interpretation, yet hospitals often require a second interpretation by a cardiologist for quality assurance purposes. Therefore, there is the potential for more than one physician to ask for payment.
Medicares policy is that payment should go to the physician who performed the interpretation in order to treat the patient, not the one who performs the second interpretation days later. So, the date on the claim form can become a bone of contention between emergency department physicians and cardiologists because it determines who will get paid.
Our sources felt that to remain ethical, you should bill the date the physician interpreted the service. However, they noted that some may argue that the date of the analysis should be used because the patients status may change in the interim. But if you choose the latter, the medical necessity of the interpretation would have to be supported on the date of the interpretation or it would not be necessary. (Although Medicare will not get involved in hospital policies, nor actively question every interpretation that comes in, they do reserve the right to deny payment if the claim appears to support only quality assurance.)