Medicare Compliance & Reimbursement

To get it right, don't forget to note separate facility addresses. Myth: You can't bill for an admission and discharge on the same day.

Truth: You can bill for a discharge from one facility and an admission to another, as long as the physician is present for both events, says Maxine Lewis, with Medical Coding Reimbursement Management in Cincinnati, OH.

"The physician would have to leave one facility and go to the next facility," Lewis explains. This happens sometimes with transfers between rehab or psych facilities, or a transfer from a hospital to a nursing home. "You discharge the patient and go to the nursing home and make sure everything's okay and sign the orders at the nursing home," she explains.

Since you can't transfer the patient's chart from one facility to the other, the second facility will require the doctor to start over from scratch. The physician has to repeat all the administrative work at the new facility that he or she did at the old facility, so it makes sense for the physician to be able to bill for the new admit, says Jo Ann Steigerwald, a senior consultant with the Wellington Group in Valley View, OH.

Important: You should note that the facilities' addresses are different. And bill the admission and discharge on separate claim forms, Steigerwald urges.

Clarification: Some confusion has come from Medicare's Internet Only Manual (IOM) 100-04 (30.6.9.1) which states that you can only bill for an admit and discharge if they don't happen on the same day. Steigerwald says the manual goes on the assumption that a transfer from one facility to another will be a transfer of care between doctors, rather than a single doctor following the patient from one facility to another.