Wiki Referring / Billing for Medicare - same provider

[brownie]

Dr Jones treats patient for cardica care. Patient is on Coumadin and needs PT INR test. In order to bill the PT - need a referring physican for the claim. There is no other physician . Dr Jones is ordering the test, is the referring for the test and the billing for the test.

Practice is being advised by electronic vendor that Medicare will not allow the referring and billing provider to be the same and has an edit in databse that rejects those claims.

We have not been able to locate a statement stating so.

Is there a guideline published by Medicare now that says the referring and billing cannot be the same?

Can someone provide a link to that guideline?

Thank you

 

[mitchellde]

You use your provider in field 17 and the qualifier for ordering provider, I forget which one they are two letters all start with D