American College of Physicians: Internal Medicine — Doctors for Adults ®

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Visiting an inpatient admitted by another physician

From the February ACP-ASIM Observer, copyright © 2002 by the American College of Physicians-American Society of Internal Medicine.

By Brett Baker

Q: Will Medicare reimburse me for visiting an inpatient on the same date that a physician not affiliated with my practice admits him or her?

A: Medicare should reimburse you for any services you provide if you explain why your visit was medically necessary. Bill the service as a subsequent hospital visit and attach a brief note or other documentation stating the reason for the visit. For example, you might explain that because of your long-running professional relationship with the patient, you needed to visit in order to adjust the care plan based on your intimate knowledge of the patient's history.

You must include a note with your claim because Medicare carriers will flag two services that physicians of the same specialty provide on the same date. Although submitting a note with the claim requires a paper claim and is burdensome, the Centers for Medicare and Medicaid Services (CMS), formerly HCFA, wants to discourage physicians from billing for what amounts to a social visit.

Medicare does allow two physicians (usually of different specialties) to bill for seeing the same patient on the same date when the physicians are treating different aspects of the patient's condition.

Q: Why doesn't CMS have a policy that accounts for this scenario?

A: CMS does not have a policy pertaining to this specific scenario because a same-date inpatient follow-up visit (for evaluation and management services) is typically performed by a physician who belongs to the same group practice, or a resident working with the admitting, attending physician.

The documentation burden is reasonable if this situation arises infrequently. If you have trouble getting your carrier to pay a claim submitted with a note or other documentation, and/or if this situation arises frequently, please contact me at 202-261-4533 or bbaker@acponline.org.

Q: How should we bill when multiple members of the same group visit an inpatient several times on the same date? How should we bill when a resident performs a same-date follow-up?

A: Your group should submit a single claim for the level of inpatient visit service-based on history, exam and decision-making-that represents all evaluation and management services that group members provided on that date.

The attending physician would bill for the services provided in conjunction with the resident—consistent with the Medicare teaching physician regulations—when the resident performed the follow-up visit. The ACP-ASIM Practice Management Center summary of the teaching physician regulations is available at www.acponline.org/pmc/teachphys.htm.

Brett Baker is a third-party payment specialist in the College's Washington Office. To ask a question about third-party payment or coding issues, contact him at 202-261-4533 or e-mail bbaker@acponline.org.

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