Wiki hospital inpatient treated in physician office

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coderknitter

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One of our physicians treated a patient in the office while the patient was an admitted inpatient in a hospital. Medicare denied our Part B claim for inconsistent place of service - CO5 as the hospital also submitted a claim for the same date of service. I was told by a Medicare rep that a Part A claim trumps a Part B claim. Can anyone advise how I can get our claim paid and who is responsible for payment? Thank you.
 
You must use the inpatient POS not POS 11. So if it was an acute care inpatient where the patient was registered then even though you treated the patient in your office, you must use the POS of where the patient is registered as a patient. So 21 for acute care inpatient. The reimbursement will be less as they will pay you as though you saw the patient in the facility.
 
LTAC Billing

Question: When a physician goes to a LTAC facility to see a patient and performs outpatient treatment services to the patient, what place of service code do we use for billing the outpatient services ( I am assuming it would be 22, for the outpatient treatment)?

Question: What NPI number should the physician bill under ( should he use his own individual NPI or the NPI of the LTAC facility)? I am assuming that the physician would bill using the NPI of the LTAC facility but, not sure.

Can you please assist me with these questions and if not can you please direct me to someone who can assist me.


Thank you
 
tmeaka@gmail.com said:
Question: When a physician goes to a LTAC facility to see a patient and performs outpatient treatment services to the patient, what place of service code do we use for billing the outpatient services ( I am assuming it would be 22, for the outpatient treatment)?

Question: What NPI number should the physician bill under ( should he use his own individual NPI or the NPI of the LTAC facility)? I am assuming that the physician would bill using the NPI of the LTAC facility but, not sure.

Can you please assist me with these questions and if not can you please direct me to someone who can assist me.


Thank you
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If your physician goes to the LTAC facility to see a patient that is registered there, you use the LTAC POS not 22. You use your provider NPI as the rendering provider.
 
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