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Medicare billing - I work at an urgent care.

  1. #1
    Default Medicare billing - I work at an urgent care.
    Medical Coding Books
    I work at an urgent care. According to the person I talked to at Medicare, we need to bill under each and every provider. Our owner is stating that she was told that we only need to bill under our medical directors as "supervising physicians".....Does anybody know where we can maybe find something in writing on this subject? How does everyone else bill Medicare? Thanks so much for any input.

  2. #2
    Location
    Columbia, MO
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    12,526
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    The rendering physician must be in 24 J and line 31. If the provider is performing "incident to" services then the supervising provider goes in 24J and line 31.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    What kind of providers are you talking about?

    Are you talking about PAs and NPs working under the "supervising" Physician Directors or are you talking about all of these providers are MDs?

    I am familiar with incident to and supervising for PAs and NPs but not or another MD.

    Just want to double check since MCare is telling you what they are telling you

  4. #4
    Default
    They have been trying to bill all providers (PAs, MDs, and DOs) under 2 MDs. I just wanted to get other opinions since Medicare is saying that this is not the way it should be done. Thanks for help!

  5. Default
    I think you need to re-look how they have been billing. Just because something has "always been done that way" doesn't mean it's correct

    And I wonder why they want to bill incident to? The reimbursement is less. (Late correction: what I intended to say was" "I can see they dont want to bill incident to. The reimbursement is less". Will put it down to bad editing or a brain lapse)

    MDs and DOs that are MCare providers with their own MC numbers must bill under that #. I am not familair with any guideline that allows one MCare MD provider to work and bill incident to another MCare MD provider

    PAs can bill under their own MC#s or work incident to and bill under the supervising MD provider's MC#

    Incident to guidelines still have to be met including supervising physician on site, New patients and establishment of treatment plans, supervising physician continued involvement etc. I don't see how these guidelines would fit with an Urgent Care facility that the majority of your patient traffic would seem to be new patients with acute problems.
    Last edited by sbicknell; 06-11-2010 at 05:35 PM.

  6. #6
    Location
    Columbia, MO
    Posts
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    Incident to reimbursement is not less it is reimbursed at the MD rate. Billing under the PA or NP number nets less reimbursed as much as 20% less in some cases. But as stated above incident to guidelines must be met. That is the physician must have already examined the pateint for the same problem AND must have a plan of care in chart which includes this visit as a followup. a physician in the same specialty in the same tax ID must be on site supervising whilethe patient is onsite. This means incident to encounters are all scheduled followup encounters. New patients and new problems must be billed out under the provider seeing the patient. This also means all your providers must be credentialed with all of your carriers. Be aware that not all carriers will credential PA and NPs.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    North Carolina
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    3,126
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    Medicare does not allow "incident to" for provider to provider. The OIG has addressed this...

    Knowing misuse of provider identification numbers, which results in improper billing; 16


    16 An example of this is when the practice bills for a service performed by Dr. B, who has not yet been issued a Medicare provider number, using Dr. A's Medicare provider number. Physician practices need to bill using the correct Medicare provider number, even if that means delaying billing until the physician receives his/her provider number.

    http://oig.hhs.gov/authorities/docs/physician.pdf

    Page 6

  8. #8
    Default
    I code Urgent care too. You have to bill every provider seperately unless they require a supervising provider or are Locum.

    showell@firstmedok.com

    It's great to find another Urgent care person out there. Keep in contact.

  9. Default
    I had related question - If group practice has a podiatrist (DPM) employed for the fixed salary – if it is allowed to bill Medicare for podiatry services provided by this doctor under MD – medical director of the group. So does that mean that the DPM is not allowed to be billed under MD?

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