Here is my response to these questions on the other thread:
http://www.medicalbillinglive.com/members/index.php?topic=7577.msg23872#msg23872Re. 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.