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Provider seeing own child

  1. Default Provider seeing own child
    Medical Coding Books
    I was curious if a provider can charge for seeing their own child. I'm just a little leary about this. I don't know if there are any state laws about this, I know they can write scripts for them, but unsure about clinic visits, because he is getting RVU's from this. Please let me know your thoughts. Thanks!

  2. #2
    Location
    Concord, NC or Rochester, NY
    Posts
    154
    Default
    Many insurance carriers disallow a provider from seeing a family member or at least billing for the services provided to the family member

  3. Default
    This is a nonbillable service a provider can not provide service to anyone in their family and charge the insurance. The reason behind this is because since it is a family member the provider has an emotional connection to them and can not be in the right state of mind to make a good clearminded decision on care

  4. #4
    Location
    North Carolina
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    Quote Originally Posted by kimberly.severs View Post
    I was curious if a provider can charge for seeing their own child. I'm just a little leary about this. I don't know if there are any state laws about this, I know they can write scripts for them, but unsure about clinic visits, because he is getting RVU's from this. Please let me know your thoughts. Thanks!
    I know this is a Medicare policy, but keep in mind that many carriers adopt many of Medicare's policies. Carriers expect the provider to provide treatment to their families gratuitously.


    130 - Charges Imposed by Immediate Relatives of the Patient or Members of the Patient’s Household
    (Rev. 1, 10-01-03)
    A3-3161, HO-260.12, B3-2332

    A. General
    These are expenses that constitute charges by immediate relatives of the beneficiary or by members of their household. The intent of this exclusion is to bar Medicare payment for items and services that would ordinarily be furnished gratuitously because of the relationship of the beneficiary to the person imposing the charge. This exclusion applies to items and services rendered by providers to immediate relatives of the owner(s) of the provider. It also applies to services rendered by physicians to their immediate relatives and items furnished by suppliers to immediate relatives of the owner(s) of the supplier.


    http://www.cms.gov/manuals/Downloads/bp102c16.pdf
    Last edited by RebeccaWoodward*; 02-24-2012 at 08:13 AM.
    Rebecca CPC, CPMA, CEMC




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  5. #5
    Location
    North Carolina
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    Default AMA's View
    Opinion 8.19 - Self-Treatment or Treatment of Immediate Family Members

    Physicians generally should not treat themselves or members of their immediate families. Professional objectivity may be compromised when an immediate family member or the physician is the patient; the physician’s personal feelings may unduly influence his or her professional medical judgment, thereby interfering with the care being delivered. Physicians may fail to probe sensitive areas when taking the medical history or may fail to perform intimate parts of the physical examination. Similarly, patients may feel uncomfortable disclosing sensitive information or undergoing an intimate examination when the physician is an immediate family member. This discomfort is particularly the case when the patient is a minor child, and sensitive or intimate care should especially be avoided for such patients. When treating themselves or immediate family members, physicians may be inclined to treat problems that are beyond their expertise or training. If tensions develop in a physician’s professional relationship with a family member, perhaps as a result of a negative medical outcome, such difficulties may be carried over into the family member’s personal relationship with the physician.

    Concerns regarding patient autonomy and informed consent are also relevant when physicians attempt to treat members of their immediate family. Family members may be reluctant to state their preference for another physician or decline a recommendation for fear of offending the physician. In particular, minor children will generally not feel free to refuse care from their parents. Likewise, physicians may feel obligated to provide care to immediate family members even if they feel uncomfortable providing care.

    It would not always be inappropriate to undertake self-treatment or treatment of immediate family members. In emergency settings or isolated settings where there is no other qualified physician available, physicians should not hesitate to treat themselves or family members until another physician becomes available. In addition, while physicians should not serve as a primary or regular care provider for immediate family members, there are situations in which routine care is acceptable for short-term, minor problems. Except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members. (I, II, IV)



    http://www.ama-assn.org/ama/pub/phys...inion819.page?
    Rebecca CPC, CPMA, CEMC




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