I do hospitalist billing. There are 2 common errors that I deal with.
1. The hospitalist acting as the admitting physician and then the specialists called in
for consults. Make sure you get the AI modifier on the Medicare patients for the H & P. While the thought process is that the AI modifier is only for inpatient admits, in the real world of Medicare (at least in my region), you need the AI on any admission (Inpatient, Outpatient, Rehab, Swing Bed, etc) to identify the admitting physician as seperate from the consulting physicians. This is based on the amount of denials I have had to fix.
2. Depending on how many specialists may be called in, the sharing of diagnosis can be a
problem. While the hospitalists is running the show in managing the big picture of the patient care, if the specialists is doing subsequent care, it can get dicey as to who can bill conditions. I am not an expert but what I can tell you based on denials, is to watch who is covering what condition. I don't know if this sounds confusing, but payors only see value in a specialist covering his/her area of expertise.
If this isn't as clear as mud, email me at
ranae.hedges@avera.org for more info and I will see if I can be more clarifying.
This is a challenging specialty as well as a learning experience. I quite enjoy the challenge of it all.
RH
