• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We’re introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

Seeing Medicare Patients but not submitting claims. ?

mitchellde

True Blue
Messages
13,291
Location
Columbia, MO
Best answers
0
If he is on admin leave then Medicare should be notified as well as the nursing home that he is not to see these patients. If he is not documenting the encounters then he cannot bill for them and since he no longer works for you you cannot bill for even if they were documented.
I think the real issue here is you have a physician that is currently not credentialed and not suppose to see these patients still providing medical care. There may be a serious legal issue here.
 

Peke

Networker
Messages
32
Best answers
0
I agree w/ Michelle. A new practice wouldn't bill for things before his start date. If he isn't suppose to be seeing patients then why is he?
 

sawhitt

Guest
Messages
27
Location
Columbus, Ohio
Best answers
0
Can anyone point me to Medicare guidelines that specifically define the following question.

We had an employed physician who was put on administrative leave and not to see any of the patients in the practice. He continued to see patients in nursing homes, rounding, ordering diagnostic testing, etc. He withheld all billing from the practice. 30 days later the practice terminated him from the practice. He still continued to see nursing home patients. As he had no way to bill for his services he just withheld all billing.
THe question is, Is this legal. If the patient is covered by Medicare or any other insurance company isn't their a contract between the patient and the insurance company and the physician and the insurance company and the physician/ patent?

Who is responsible for the care of the patients when the results of the testing is going thru the practice's EMR even thought now since the physician has been terminated he is not credentialed with any practice, has not billing address, and no way to receive results of the the labs and other testing he is ordering.
With the now unemployed physician still seeing these patients and calling them his own, is the practice or the physician responsible for those patients.

I would appreciate any direction in finding Medicare rulings or anything in writing I can use.
 
Top