Magazine article Medical Economics

Coding Cues: Answers to Your Questions about . .

Magazine article Medical Economics

Coding Cues: Answers to Your Questions about . .

Article excerpt

Billing for an on-call arrangement

I'll admit a patient to the hospital, but the doctor I have an on-call arrangement with will make rounds on him. Is there a way for me to bill Medicare and get reimbursed for the services the on-call physician provides?

Perhaps. If you never provide inpatient services, but use an "on-call" doctor instead, you can't bill for the services that physician provides. He or she must bill for them independendy.

But if you're part of a call group that covers for each other on weekends or holidays, for example, "on an occasional reciprocal basis," you may submit a daim to Medicare using your NPI and legacy PIN to receive payment. The following conditions apply:

* The substitute physician can't provide services over a continuous period of longer than 60 days. Ongoing, once-a-month call coverage doesn't constitute "continuous."

* You must attach modifier -Q5 to the procedure code on the claim form.

* You must keep a record of each service provided by the substitute physician, along with his or her provider numbers.

NPI information errors

We've been submitting claims using both our NPI and legacy provider numbers without a problem. But suddenly, a lot of our claims are being rejected and our billing department can't figure out why. Has anything changed?

Yes. Some carriers have begun to reject daims if the NPI and legacy information don't match what's on file with the NPI Enumerator. You'll see one of four error codes on the remittance advice: M340, M341, M343, or M347. These all represent "NPI/Legacy combination does not match the NPI crosswalk." These errors can be caused by something as simple as having failed to include the complete legacy number on the CMS registry application form when you applied. Checking the information in the NPI file and correcting anything that doesn't match will resolve your problem. You can edit your records by going to the NPI Enumerator at https:llnppes. …

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