Wiki Billing professional component to inpatient with Medicare Part A

[mstrickler]

I bill for a radiologist who is a contractor (not employed by hospital). I have been told we cannot bill Medicare Part A - even when patient is inpatient at hospital. We are billing professional component only. If we can’t bill Part A it rolls to self-pay. This doesn’t seem right as patient can’t chose who is on staff or contract services.

 

[thomas7331]

Part A coverage is strictly limited to certain benefits, mainly for inpatient facility claims, but also including some home health and blood administration services, for example. But almost all professional services are covered under Medicare Part B, whether rendered in an inpatient or outpatient setting and whether employed by the hospital or not. If the patient has no Part B and no other insurance coverage, then the patient actually is self pay for physician services.

Usually if a patient is eligible for Part A but does not have Part B coverage, it is by their own choice as they have decided not to pay the Part B premiums to enroll. It doesn't have anything to do with the patient not being able to choose who is contracted or on staff at the facility.

 

[JLRees]

I agree with Thomas, if you are looking to get payment on professional services only then the patient would need to have Part B coverage, or some other form of insurance. Part A is for facility/technical component. The hospital that your radiologist works in gets paid for the use of their equipment under Part A, but the radiologist himself is only eligible for reimbursement for the professional component under Part B. It seems being a contractor in a hospital might not be the best set up for your radiologist.

 

[mstrickler]

I agree with Thomas, if you are looking to get payment on professional services only then the patient would need to have Part B coverage, or some other form of insurance. Part A is for facility/technical component. The hospital that your radiologist works in gets paid for the use of their equipment under Part A, but the radiologist himself is only eligible for reimbursement for the professional component under Part B. It seems being a contractor in a hospital might not be the best set up for your radiologist.

Thank you! Very helpful.