| After hours coding? Here's a word of caution: You | | | | party is not compensating him for his time, |
| can't catch ER coverage services with after-hours | | | | suggests Barbara J. Cobuzzi, MBA, CPC, CENTC, |
| codes. If you bill the wrong way when your | | | | CPC-H, CPC-P, CPC-I, CHCC, president of CRN |
| physician covers for others — or for that | | | | Healthcare Solutions, a coding and reimbursement |
| matter when another physician covers for your | | | | consulting firm in Tinton Falls, N.J., and senior coder |
| physician — you could be setting yourself up | | | | and auditor for The Coding Network. |
| for charges of fraud. | | | | For instance: If your office closes at 5 p.m. but |
| Avoid the hassle: Keeping in mind these few | | | | your physician sees a patient on an emergency |
| simple answers to the top three on-call billing | | | | basis at 7 p.m., you should report 99050 in |
| questions will help you correctly file claims. | | | | addition to any other services provided. You |
| 1. Which doctor bills for the services? | | | | should not report 99050 if your physician saw the |
| If your physician is on call and handling patient | | | | patient in the emergency room at 7 p.m. |
| services for another physician, don't make the | | | | 3. Can billing be skipped altogether? |
| mistake of letting the other physician bill for the | | | | You may be desirous to simply arrange a |
| services. Although a patient sees a particular | | | | substitute arrangement with other practices for |
| physician, that does not imply that the physician | | | | your physicians to cover for one another at |
| can bill for any services related to that patient's | | | | various times. This, however, sets your practice |
| care. When your physician provides a service, you | | | | up for financial liability and lost reimbursement. |
| should bill the services even if your physician is on | | | | "Reciprocal billing" works only for two practices |
| call for another doctor. | | | | that have similar size practices with similar patient |
| Bobbi M. Bohon, CPC, of Seven Hills Surgical in | | | | and similar acuity and whose doctors perform |
| Lynchburg, Va, says, "I bill for those billable visits | | | | nearly equal coverage. |
| when my surgeon is on call and covering for the | | | | Reason behind: This type of arrangement saves |
| other surgeons in town." | | | | on paperwork, but it isn't realistic to assume that |
| Verify the NPI: Joseph A. Lamm, office manager | | | | the workloads between the physicians will all even |
| for Stark County Surgeons in Massillon, Ohio, | | | | out over time. One physician might end up with a |
| suggests "Each doctor who sees a patient should | | | | very time-consuming patient to deal with. So |
| bill for the appropriate services rendered under his | | | | assuming that the inequities will all balance out in |
| her own NPI (National Provider Identifier) number." | | | | the end just doesn't work. Each physician should |
| Hint: Bohon says, "The physician who sees the | | | | bill for the work he performs. |
| patient face to face and documents and signs his | | | | Hint: Lamm says, "You may desire to have a |
| her name should bill for those services provided | | | | healthcare attorney to review your on-call billing |
| regardless of who the admitting surgeon is." | | | | arrangements to ensure that you're not |
| 2. How to report on-call ER services? | | | | fraudulently reporting services." However Medicare |
| Many times, physicians tend to patients in the | | | | does recognize "reciprocal billing" and even has a |
| emergency department while on call. Don't run for | | | | modifier to indicate when you are participating in |
| the after-hours codes to bill these services when | | | | reciprocal billing. You can use modifier Q5 (Service |
| the hospital pays your physician for being on-call. | | | | furnished by a substitute physician under a |
| Reason behind: You cannot bill twice for the | | | | reciprocal billing arrangement) to indicate to your |
| physician's services if the hospital is already paying | | | | Medicare carriers that you're participating in a |
| him to be on-call physician in the emergency room | | | | reciprocal billing arrangement, Cobuzzi says. Private |
| (ER). You should bill the after-hours codes 99050 | | | | payers, on the other hand, don't require a |
| (Services provided in the office at times other | | | | modifier when you're doing reciprocal billing. |
| than regularly scheduled office hours, or days | | | | Important: Cobuzzi concludes, "Remember that by |
| when the office is normally shut [e.g., holidays, | | | | using the Q5 modifier, you are telling Medicare |
| Saturday or Sunday], in addition to basic service) | | | | that the billing physician is not the actual rendering |
| and 99058 (Service[s] provided on an emergency | | | | physician, as without a modifier, a private payer |
| basis in the office, which disrupts other scheduled | | | | who has not given you a sanction in writing for |
| office services, in addition to basic service) only | | | | reciprocal billing may interpret it as billing for |
| when your physician sees a patient in your office | | | | services that were not provided. |
| outside regular office hours and another third | | | | |