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lburgos31

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If our practice has privileges to perform consults in a Hospital setting, and a hospital employed resident completes the consult for our provider, when would it be ok to bill the Hospital Care?

Wouldn't our provider need to be employed by the Hospital (and be an attending) in order bill for that resident's consult, even if it was within their scope of practice?

What would our providers need to bill for residents that are not employed by our practice? Or can that not be done?

I've checked the CMS PA/NP Teaching Physicians Guide but it does not answer my questions.

Thanks.
 
I have worked for 2 large clinics that see patients at Hospitals that have residents. Our physicians are not always the attending. Residents here will rotate through different specialties and be available at the Hospital for different shifts.
They are supervised by "Teaching Physicians"...so for instance if a resident was rotating through Gastroenterology and our GI physician was on-call...he/she might have the resident see the patient while waiting for our physician to arrive.
Our physician would also see the patient and use the same chart note as the resident but add a signed attestation. An added paragraph or addendum stating he/she saw the patient and agrees with the residents note or not or add to it.
With an addendum or attestation to the note our physician would be able to bill for services. Residents are paid by the Hospital so they don't bill for individual patients...
but your physician must also have seen the patient face-to-face to bill for services. If your physician spoke to and/or read the residents note that is not enough to bill a patients insurance for services.
 
Hi! Thanks for the reply. I am assuming in the addendum or attestation the physician would need to document that he/she saw the patient face to face or examined the patient...in order to bill the service otherwise it wouldn't count right?
 
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