Wiki Inpatient consultation billing MD combined with psychologist, does it effect payment for MD

[Butterfly1]

My practice doctor was seeing patients at local hospital and getting paid by hospital for some patients. For rest, was told to bill in house. We did it. During this time, the psychiatrist (MD) and the hospital employee psychologists were separate billing groups. Now the hospital changed electronic record system and put psychiatrist and psychologist in one group.
1- The doctor is asking me to find out if the hospital is getting better payment for psychologists for having a MD in the group, and making money off of him. Can some one please guide?
2- Also we get a lot of denials of payments, esp medicaid that the payment was already made, we cannot figure it out. He says denials have increased after change of EHR. Please guide.
3- Should codes 99221-223 be used for initial consults and 99231-233 used for follow ups? Can I bill 90792 or 90791 for in patient consult of psychiatric evaluation?

 

[SharonCollachi]

It is generally better for the provider if they are independent of the hospital, and bill insurance themselves.

I'm a bit unclear on the setup of "separate billing groups". Are you talking about the way the hospital pays the doctors, or the way the insurance companies pay the doctors? Just changing EMR does not change corporations, or tax IDs, or group NPIs... if the hospital has an employee group that they bill for, then that is not changed by an EMR change.

1. If the hospital wasn't making money off him, they wouldn't be doing it. See my first statement above. Although, I am unclear how they are billing the insurance companies for the PhD vs the MD.
2. That means the hospital already billed Medicaid for the same services that you are billing Medicaid for.
3. 99221-99223 for Admit or Initial Eval (although some insurance companies only let the Admitting Physician bill those codes, and in that case use AI modifier). 99231-99233 for followups. You can use either the 9079x or the regular hospital codes for the psych.

 

[Butterfly1]

Well it is confusing. The MD goes and see the patients and gives us the codes and we bill for him.
The hospital says that they bill for his services too (which I am not sure how that can be done, may be they use hospital tax ID), but the hosp Med Director told him to do his own billing too.
Now old EHR had psychology department (employees of the hospital in a different group in old EHR) and he was independant in EHR. New system shows that him as psych and the psychologist as neuro psych are together as (psych/neuropsych) in notes etc etc, psychology is called in earlier now (in past they were called after him) and now our billing here has more refusals than payments. He things that now psychologist notes as psych/neuropsych may have increased psychologist payments and the insurances are refusing to pay us.
Can this happen?
Can hospital do this without his permission?
He asked an EHR staff who said, no they made sure that they did not have overlapping codes between him and the psychology department? What is this about? Psychologist codes should not be similar as his other than 90791 otherwise I cannot think of any other codes that could be common. But if this code is billed, he is MD and they are psychologist, then why do we get denial? Saying services already paid? Please help sort this out.

 

[Butterfly1]

Does it matter if the hospital switches to shared billing?

 

[SharonCollachi]

Does it matter if the hospital switches to shared billing?

You're going to have to be more specific about what you mean by that.

 

[SharonCollachi]

Well it is confusing. The MD goes and see the patients and gives us the codes and we bill for him.

This is how it should be.

The hospital says that they bill for his services too

This is incorrect. The hospital does not bill for MD services, they bill for facility. Since the patient is already inpatient, they are already billing their portion (room&board, etc.). I would ask for a printout of exactly what they are billing for him.

(which I am not sure how that can be done, may be they use hospital tax ID), but the hosp Med Director told him to do his own billing too.

Same as prior - I don't know what they're doing either.

Now old EHR had psychology department (employees of the hospital in a different group in old EHR) and he was independant in EHR. New system shows that him as psych and the psychologist as neuro psych are together as (psych/neuropsych) in notes etc etc, psychology is called in earlier now (in past they were called after him) and now our billing here has more refusals than payments. He things that now psychologist notes as psych/neuropsych may have increased psychologist payments and the insurances are refusing to pay us.

I would need some specific denials to know what is going on. I really think you need to see what the hospital is billing. An MD and a PhD can see the patient the same day, but if the neuropsych happens to be an MD, and your psychiatrist is seeing the patient the same day, that might be a problem. Or it could be that if the hospital is billing the doctors as a group, then the services would be combined and billed as if one person performed them.

Can this happen? Can hospital do this without his permission? He asked an EHR staff who said, no they made sure that they did not have overlapping codes between him and the psychology department? What is this about? Psychologist codes should not be similar as his other than 90791 otherwise I cannot think of any other codes that could be common. But if this code is billed, he is MD and they are psychologist, then why do we get denial? Saying services already paid? Please help sort this out.

More and more, I think there are shenanigans afoot (showing my age now). The hospital needs to stop billing anything on his behalf immediately. They cannot bill for his services without his permission (which may have been on a contract he may have signed eons ago).

So here is my (suggested) plan of attack.

1. Write a letter to all parties

To Whom It May Concern:

It has come to my attention that there are other entities that are billing for services I have rendered. You are instructed to IMMEDIATELY stop billing for any services that I have personally provided. You are instructed to provide me with a detailed report of every service you have billed, in the last six months [insert however many months this has been going on] in my name, my license number, my tax ID number, and/or my NPI number, within TEN calendar days.

Should you fail to comply with either of these two instructions, I will consider you to be willfully committing insurance fraud, and I will take further action.

Be aware that I plan to investigate every service that I have billed that has been denied saying the services were already paid, and I fully expect the responsible entity to pay me for my services, or refund the money back to the insurance companies so that they may pay me directly for my services.

At this point, I assume this situation has come about due to ignorance and not fraud or malice; however, should the situation not be rectified immediately, one would reasonably assume the opposite.

2. Send this letter to a specific person at each, by certified mail with a signature, and cc it to anyone who is vaguely involved.
3. Be prepared for what is to come next - what will your plan be if they do not comply? Is he willing to report them for fraud? Is he willing to stop practicing there if they force him out? <-- if he's not getting paid, why would he want to work there anyway - they're stealing his income.

Good luck.