I work in an outpatient medical and mental health clinic with 2 locations. My location is mainly admin staff and social workers. We do have an ANP and an RN at this location, but the ANP is moving his office to our other location. The problem is that the nurse wants to remain here and continue to perform med injections and lab draws. Is this allowed? I don’t see how we can bill for these services with no supervising provider present. This is a totally new experience for me so I am totally confused about this. Most of our patients are Medicaid and Medicare, but we do see some other insurances as well.
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Tag Archives: Services
Billing OB Global for services split between 2 different Tax ID’s/NPI’s
My BCBS of AL Prover Rep instructed me to ask this question to AAPC. I have a Hospital owned OB/GYN clinic in a rural area that has just opened that is staffed by a nurse practitioner. Her supervising physician will be there some, but not all the time. The supervising physician is employeed by the hospital, but is in a practice with another OB/GYN and his billing is done through the other practices NPI and Tax ID.
I spoke with the Maternity Care group that pays for AL Mediciad OB Global to ask how to bill them and was informed that the physician will have to bill the OB Global and the NP will need to be reimbursed from that office. I believe that we need to bill all payers this way.
We had an OB/GYN that left last July so all his patients had to transfer. I had to do a lot of antepartum billing for him. Certain payers such as BCBS denied the claims requiring me to list the Antepartum span dates from the First (New) OB visit to the last visit. Under this new set up, we will have overlapping dates of service between the two pactice locations. The NP will see the OB patients from the New OB until 20-24 weeks. The patient will go to the Physician’s office one time between 20-24 weeks then back to the NP. The patient will be treated by the NP until 35 weeks. At 35 weeks and after, they will go to the Physician’s office until delivery. Since we will have overlapping dates, I cannot enter these dates on the claim, since the claims will deny for overlapping services.
Originally, this was supposed to be Cash pay patients that only had Emergency Medicaid that would cover the delivery. We would charge a set cash price for each antepartum visit (at either office) and the physician would bill Mediciad for the Delivery. Our set up is fine in this situation.
Now, they are marketing to patient’s in the (rural) area that have insurnce and BCBS is a big provider in the area. This has now complicated the OB Global billing, since we have two separate locations under different NPI/Tax ID’s. Help!
I believe that all insurred patients should be billed by the physician and that office have a contract on what to reimburse the NP services for. I need confirmation for this, and I have a feeling that this type of set up has not been done before which makes setting up the charges and billing for this a bit challenging.
I appreciate any help I can get.
Rose Patterson :confused:
Translation Services
Does anyone know how to bill for translation services? I see T1013, however the code has been denied, because the service is not medical? I need some assistance. Also, would someone know the payers code?
Thank You,
Prolong services
65 minutes spent on the phone with Humana and preparation of paperwork for appeal process
22 minutes spent in discussion with the patient
10 minutes spent in coordination with case manager
See today’s separate progress note as well
22 minutes spent in discussion with the patient
10 minutes spent in coordination with case manager
See today’s separate progress note as well
97 mins total
This is a portion of a note that clarifies the time part for coordination of care.
how would you code this?
Two E/M Services, Same Day at Same Clinic, But Two Providers? What modifier??
Hello! So I work for a clinic, where we have a bunch of different providers who do different things, but they are all under E/M codes. So I just ran into something that I have never seen before. I was entering a 99215 encounter for a provider, and I saw that our EMR system automatically put it on hold because there was a 99214 billed the same day but for a different provider. I cannot use -25 since it is a different provider, and I cannot use -59 since it cannot be attached to an E/M code. I read through every modifier and none will work. In this situation, does the E/M code need a modifier? And if so, which one should I use??
Thank you!!
Thank you!!
Billing Professional services for X-Rays Outside reads
Hello,
I was asked can a Hospital Bill the Professional component for the x-ray if the radiologist is charging the Hospital for reading and not billing the insurance?
Thank you,
Is it mandatory for all services to be billed?
Just a curious question.
If a physician reads radiology xrays, EKGs, etc and the biller missed billing the professional component (due to paper shuffle, some may be missed), is that "illegal"?
A biller at our office says that it will harm the patient and it will cause trouble for the practice?
She also says that if insurances didn’t get the code the xray to specificity the patient might get future services denied by insurances? (E.g. arthritic degeneration of knee if not coded, may get denied for knee replacement surgery)
I’m not understanding why insurances would base on codes and not the physician’s notes. Most of these procedures require pre auth.
Thanks for clarifying.
Compliance Issue: NP and Physician E/M Services
Per CMS new patient services must be personally performed by a physician with the exception of history obtained by ancillary staff.
If a nurse practitioner sees a new patient in the office to obtain the history and perform an examination but then passes the encounter off to a physician who conducts a pertinent exam (one body system/part) and determine the A/P, does this suffice as personally performed?
It is essentially a split/shared service in an outpatient office that is being performed. Does the physician need to do the entire E/M themselves or can the elements be divided between the physician and NP?
If a nurse practitioner sees a new patient in the office to obtain the history and perform an examination but then passes the encounter off to a physician who conducts a pertinent exam (one body system/part) and determine the A/P, does this suffice as personally performed?
It is essentially a split/shared service in an outpatient office that is being performed. Does the physician need to do the entire E/M themselves or can the elements be divided between the physician and NP?
“Other outpatient services”
I work for a cardiologist who is on staff at a local hospital. He was consulted by an ED physician to see a patient who was on observation status. We billed for the consult and next day visit with observation codes but received a denial from Medicare. Another biller in the office called Medicare and they told her that we could bill 99215 (office visit code) for the consult and subsequent visit for POS: 22.
Myself and my supervisor have never heard of this being done. Medicare actually paid the claim :eek:. Has anyone else billed any 99201-99215 codes for patients seen in the hospital on observation status?
Myself and my supervisor have never heard of this being done. Medicare actually paid the claim :eek:. Has anyone else billed any 99201-99215 codes for patients seen in the hospital on observation status?
Step Outside Your Coding Bubble into FQHC Services
Compare coding and billing for FQHCs to that of provider- and facility-based organizations. Federally qualified health centers (FQHCs) account for less than 10 percent of designated organizations, but as coding professionals we should understand the differences between FQHCs and physician- or facility-based organizations. Note: Medicare, Medicaid, and commercial carriers do not all process FQHC claims […]
The post Step Outside Your Coding Bubble into FQHC Services appeared first on AAPC Knowledge Center.