Now that we are all a part of our hospital and linked under one Tax ID we have found some issues with billing for our physicians. Here are some of the scenario's I was emailed:
You can bill for the office visit when the patient is admitted, unless the admitting physician ALSO sees the patient on that same day On the hospital floor (not in the office).
Here are some scenarios to make it clearer. Our NP admitted someone yesterday..
1. NP sees the patient in the office on Monday, and decides the patient needs admission. She calls the physician that over see's the NP's in that practice, she writes the orders etc. The overseeing physicians first time seeing the patient in the hospital is on Tuesday morning. NP bills an office visit for Monday, overseeing Physician bills the admission visit on Tuesday.
2. NP sees the patient in the office on Monday, and decides the patient needs admission. She calls the overseeing Physician, writes orders etc. The overseeing Physician goes in and sees the patient up on the hospital floor the same Monday. Either the NP bills, or overseeing Physician , but not both.
NP sees the patient in the office on Monday, and decides the patient needs admission. She talks to the overseeing Physician , who goes into the office room with NP to see the patient before they go upstairs to the hospital floor. overseeing Physician doesn't see the patient up on the hospital floor until Tuesday morning. NP bills an office visit for Monday, overseeing Physician bills the admission visit on Tuesday.
The problem that wasn't getting answered is what if isn't the overseeing Physician , but the surgeon or a physician from another office. These doctors are not part of that practice specifically, but they share the tax ID number. Scenarios 1 and 3 aren't an issue still. Scenario 2: logically, not being part of our practice, both NP and the doctor should be able to bill. However, depending on how the business tax etc entity is built, it may be that both providers billing would look like a double bill to an insurance carrier. However, we need to be sure the NPs are still getting recognized for their work, even if they can't bill.
Another problem is that other practice physicians sometimes have the NP send the patient to the ER, after the NP does all the work, and then the ER doctor sees the patient and admits them. Whether or not the NP can bill the office visit is a question, for similar business tax entity reasons. Another question would be when the doctor sees them in the office but another doctor admits them to the hospital with the same tax ID. Also, what if they are seen in the office but then go to the ER later. They are not admitted but, they are seen in the ER. Can both physicians bill?
Any Advice you can give would be great! Thanks for your Help!
You can bill for the office visit when the patient is admitted, unless the admitting physician ALSO sees the patient on that same day On the hospital floor (not in the office).
Here are some scenarios to make it clearer. Our NP admitted someone yesterday..
1. NP sees the patient in the office on Monday, and decides the patient needs admission. She calls the physician that over see's the NP's in that practice, she writes the orders etc. The overseeing physicians first time seeing the patient in the hospital is on Tuesday morning. NP bills an office visit for Monday, overseeing Physician bills the admission visit on Tuesday.
2. NP sees the patient in the office on Monday, and decides the patient needs admission. She calls the overseeing Physician, writes orders etc. The overseeing Physician goes in and sees the patient up on the hospital floor the same Monday. Either the NP bills, or overseeing Physician , but not both.
NP sees the patient in the office on Monday, and decides the patient needs admission. She talks to the overseeing Physician , who goes into the office room with NP to see the patient before they go upstairs to the hospital floor. overseeing Physician doesn't see the patient up on the hospital floor until Tuesday morning. NP bills an office visit for Monday, overseeing Physician bills the admission visit on Tuesday.
The problem that wasn't getting answered is what if isn't the overseeing Physician , but the surgeon or a physician from another office. These doctors are not part of that practice specifically, but they share the tax ID number. Scenarios 1 and 3 aren't an issue still. Scenario 2: logically, not being part of our practice, both NP and the doctor should be able to bill. However, depending on how the business tax etc entity is built, it may be that both providers billing would look like a double bill to an insurance carrier. However, we need to be sure the NPs are still getting recognized for their work, even if they can't bill.
Another problem is that other practice physicians sometimes have the NP send the patient to the ER, after the NP does all the work, and then the ER doctor sees the patient and admits them. Whether or not the NP can bill the office visit is a question, for similar business tax entity reasons. Another question would be when the doctor sees them in the office but another doctor admits them to the hospital with the same tax ID. Also, what if they are seen in the office but then go to the ER later. They are not admitted but, they are seen in the ER. Can both physicians bill?
Any Advice you can give would be great! Thanks for your Help!