Wiki advice??

[lburgos31]

If our practice has privileges to perform consults in a Hospital setting, and a hospital employed resident completes the consult for our provider, when would it be ok to bill the Hospital Care?

Wouldn't our provider need to be employed by the Hospital (and be an attending) in order bill for that resident's consult, even if it was within their scope of practice?

What would our providers need to bill for residents that are not employed by our practice? Or can that not be done?

I've checked the CMS PA/NP Teaching Physicians Guide but it does not answer my questions.

Thanks.

 

[SharonCollachi]

Shared visits in a hospital setting can only be done by two members of the same group practice. Here is one Medicare Contractor's Article on it.

You can only bill for what your provider, or providers employed by your group, performs. I would be questioning what "completes the consult for our provider" means.

Here is another article about who is eligible for this arrangement; see the notes about leased employees, and particularly this gem: Additionally, shared/split services do not apply to physicians in training (interns, residents, fellows) or students.

 

[csperoni]

The shared visit rules do not apply here. It is the teaching physician rules. Typically, the resident may write the note, but your physician must add the required attestation which basically states they were personally present, examined the patient, etc. Your other posted question about this in the E/M forum has the detailed answers.

https://www.aapc.com/discuss/threads/advice.171344/?view=date#post-467039

 

[SharonCollachi]

Ah, I wasn't thinking about the teaching aspect. Thank you!