Wiki Referring Physician for tests

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brownie

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This is the scenario-

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
 
brownie said:
This is the scenario-

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
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I don't remember hearing anything about this. We are still billing services to Medicare in which the ordering and performing provider is the same (not labs, but other diagnostic tests that do require an ordering provider); our MAC is Novitas, and we haven't had any denials for this reason.

The only other change that Medicare has made recently (that I'm aware of) regarding Referring/Ordering requirements, is that all providers that order or refer services for Medicare beneficiaries, must enroll in Medicare in order to continue to order/refer, even if they do not accept Medicare. Here's a link to the most recent MLN I could find on that topic:


http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/downloads/mm6421.pdf

Hope this helps somewhat.
 
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