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Physician Billing for Physician - Help

  1. #1
    Default Physician Billing for Physician - Help
    Medical Coding Books
    I am in need of finding some documentation to prove to some physicians that the can not do the following scenario:

    Physician A is under an NIH Grant. Physician A sees patient and dictates. Physician B is NOT under the NIH Grant. He sees patient and agrees with plan of care dictated by Physician A.

    Physician B wants to bill for these services, but he did not do the work. He is simply signing off that he agrees with Physician A's plan of care. Physician A is being reimbursed by the NIH Grant, so physician B cannot bill anyway because this would be double dipping.

    If anyone has any documentation I would greatly appreciate it.

    Thanks

  2. Default
    Quote Originally Posted by aslonsky View Post
    I am in need of finding some documentation to prove to some physicians that the can not do the following scenario:

    Physician A is under an NIH Grant. Physician A sees patient and dictates. Physician B is NOT under the NIH Grant. He sees patient and agrees with plan of care dictated by Physician A.

    Physician B wants to bill for these services, but he did not do the work. He is simply signing off that he agrees with Physician A's plan of care. Physician A is being reimbursed by the NIH Grant, so physician B cannot bill anyway because this would be double dipping.

    If anyone has any documentation I would greatly appreciate it.

    Thanks
    It is difficult to determine from the information provided. Have you reviewed the grant language? Physician B actually sees that patient? Who is he billiing for the services and what documentation does he chart? Does he do a physical exam of the patient or is it a counseling visitThe patient's health insurance carrier? Is the patient part of a study being performed by Physiican A and he is referring them to Physician B for a second opinion?

  3. #3
    Post
    Quote Originally Posted by aslonsky View Post
    I am in need of finding some documentation to prove to some physicians that the can not do the following scenario:

    Physician A is under an NIH Grant. Physician A sees patient and dictates. Physician B is NOT under the NIH Grant. He sees patient and agrees with plan of care dictated by Physician A.

    Physician B wants to bill for these services, but he did not do the work. He is simply signing off that he agrees with Physician A's plan of care. Physician A is being reimbursed by the NIH Grant, so physician B cannot bill anyway because this would be double dipping.

    If anyone has any documentation I would greatly appreciate it.

    Thanks
    This is from an Article on Physician's Practice:

    "Giving Credit for Exam Work?
    By Bill Dacey | December 8, 2010

    --------------------------------------------------------------------------------


    Question: If an advanced registered nurse practitioner sees a patient for an inpatient consult and dictates: "See H&P notes and labs in chart" in her exam section, then only notes vitals and mental status exam, can I give her credit for work in the exam piece in the H&P when it was completed by another physician?

    Answer: Is she billing a consult separate from the other physician? Or are they collaborating on the same day with one charge going out? If it's the former, and the other doc is using that H&P as part of his or her admit or other bill, then she can't use it. The work involved in performing the physical exam or any other part of a given visit belongs to that visit and its associated code, charge, and payment.

    You can't "borrow" work that has been previously performed, claimed, and paid for and include it in a new code you are presenting for payment — it's double dipping.

    If it's the latter case, and these two providers are collaborating with one bill going out, then reference Medicare's consult guidelines: "Carriers shall instruct physicians and qualified NPPs that a consultation service shall not be performed as a split/shared evaluation and management service."

    Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 20 years. He can be reached at billdacey@msn.com or physicianspractice@cmpmedica.com.

    This question originally appeared in the February 2010 issue of Physicians Practice.



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