MnTwins29
True Blue
I think the answer is self-explanatory - no, the hospital cannot bill Medicare for a procedure done by a non-participating physician, but I am having trouble finding the specific reference. Does anyone know of this? Thank you.
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Wiki Procedure done in hospital by non-par MD - can hospital bill?
- Thread starter MnTwins29
- Start date
Pam Warren
True Blue
How did the provider get priveleges if they're non-par with Medicare? We require that, but maybe it's not required by your facility?
MnTwins29
True Blue
Emergency situation(s)
This was a special case - on-call dentist who does provide services for such injuries as fractures, etc.. Normally, the MD does need to par, but this particular doc either slipped through or an exception was made. That is a separate question our to our VPMA.
This was a special case - on-call dentist who does provide services for such injuries as fractures, etc.. Normally, the MD does need to par, but this particular doc either slipped through or an exception was made. That is a separate question our to our VPMA.
mitchellde
True Blue
if this was performed as an emergency then there should be no problem with the facility billing Medicare. If you did not notify Medicare within 48 hours of the surgery then it may be a problem, or maybe they do not require that anymore. You should check with you Medicare FI on this.
MnTwins29
True Blue
Thank you to both of you for responding. I have obtained some more information that wasn't relayed to me before. I heard it third-hand at first, but when I called our medical staff services offices, it was something different. The dentist has opted out of Medicare vs. being a non-par provider and more importantly, he ORDERED the procedure, did not perform it. So, given those two pieces of information there is no issue - providers who opt out can order procedures and the hospital will be paid.
Shows what some follow-up footwork can do!
Shows what some follow-up footwork can do!