Author Topic: Repost under correct category- Billing for emergency visit  (Read 1019 times)

wildcat1842

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Repost under correct category- Billing for emergency visit
« on: November 12, 2013, 10:49:54 AM »
Sorry, I had posted this under coding. Thank you Richard for responding. Just want to hear other thoughts  ;)

Hello! One of our dr's is the ophthalmologist on call for the week for some of the local hospitals. I have only ever billed for her work in the private practice. So I have three questions:

1. How do I code the visit when she see's the patients in the hospital? Or is this something the hospital bills? Just change the place of service?  What if we are not contracted with the patient's insurance?

2. Those patients she saw in the hospital are also coming for follow ups in our office, how do I bill those visits to show it was an ER follow up?

3. New patients are calling the hospital with eye problems and the hospital is referring them to our dr since she is on call. How do I bill those insurances that we are not contracted with (is there a modifier that says it was an ER and she was on call)?

Thank you!

RichardP

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Re: Repost under correct category- Billing for emergency visit
« Reply #1 on: November 12, 2013, 07:26:14 PM »
Here is my response to these questions on the other thread:

http://www.medicalbillinglive.com/members/index.php?topic=7577.msg23872#msg23872

Re. your Question 3:  the hospital is referring them to our dr since she is on call.  You then ask about ER billing.  So - do the patients referred to your doctor come to your office?  Or does your doctor go and see the patients in the ER?  If the patients come to your office, they would be billed as a new-patient office visit, plus whatever procedures were performed there.  If your doctor goes to the ER, the next paragraph would govern.

Can you please clarify what you mean by on call for the week for some of the local hospitals?  Have the hospitals hired your doctor?  If they have, your doctor will be paid by the hospital and you would not be billing anything.  If the hospitals have not hired your doctor, and your doctor will get paid directly by the insurance carriers, then my answer given at the link above (and repeated below) is correct.

If the hospitals are not paying your doctor directly, then your doctor will bill for services performed, and the hospital will bill for facility fees and for the services provided by the hospital's staff.  But note that at least Medicare will want to know whether the patient was serviced as inpatient (admitted to the hospital) or outpatient (services performed in hospital, but patient not admitted) by your doctor.

If the hospitals are not paying your doctor directly, you would bill the insurance as an out-of-network provider.  If the patient does not have out-of-network benefits, they will personally be responsible for paying your doctor's fee.  If your doctor has not informed the hospitals that she is out of network on some (all?) insurances, it would be useful for your doctor to do so.  Neither your doctor nor the hospitals need really angry patients dissing both of them because the patient thought their insurance was going to cover the cost, only to find out that it won't.  I speak from experience on this one.

Merry

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Re: Repost under correct category- Billing for emergency visit
« Reply #2 on: November 12, 2013, 09:12:07 PM »
If the patient does not have out-of-network benefits, they will personally be responsible for paying your doctor's fee. >,

In CA, a person going to an ER cannot be billed out of network. The drs must negotiate with the plans. Good to check with state regs.

RichardP

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Re: Repost under correct category- Billing for emergency visit
« Reply #3 on: November 12, 2013, 09:53:09 PM »
Thanks for the additional detail Merry.  The emphasis of my last paragraph was to make certain the patient was not surprised by an unexpectedly high ER charge because the doctor is out of network.  Your advice to check with state regs re. how the out-of-network doctor can bill is a useful addition to that caution.

Edit:  change "who" to how" in last sentence.

Do you have any advice for how to bill a person who has no insurance and is treated in the ER?
« Last Edit: November 13, 2013, 11:47:24 AM by RichardP »

Merry

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Re: Repost under correct category- Billing for emergency visit
« Reply #4 on: November 12, 2013, 11:09:39 PM »
Talk to billing supervisor and negotiate for the Medicare rates, then pay $10 a month.