Denial due to Part A

ls0403

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Boone, NC
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We saw a patient in our office on same date they were discharged from an inpatient stay at hospital (OV, xrays, FX care). We never saw the patient at the hospital. Mcr denied stating claim not covered by this payer/contractor. I sent appeal w/ copy of discharge showing patient was seen in our office later that date, after dischage. Appeal denied stating services done in an office setting, with a DOS that falls within our admission/discharge date on a hospital IP bill, should be billed to Part A.

I'm really stumped on this one. Do I need to send our charges to Part A? Any opinions would be appreciated.

Lisa
 

Lisa Bledsoe

True Blue
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Greeley, Colorado
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Was it one of your providers who discharged the patient? Is the visit unrelated to the hospital stay? Is the patient a resident of a nursing home? All of these will impact what you can bill for the OV and procedures to Part B. If your providers discharged and these services are not related to the discharge, I would use modifier -24. If the patient is a nursing home resident you can only bill the professional component for radiology to Part B, the technical component would be billed to the nursing home.

Anyone else?
 

ls0403

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Boone, NC
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Thanks for your response. My physicians didn't see patient at hospital. He was discharged by hospitalist and referred for ortho follow-up. Somehow he was seen here right after the d/c. He wasn't in a SNF on that date.
 
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