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CAPC Palliative Care Discussion Forum
Billing and Finance

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Post outpt. billing
Author: stiffl
Date: Dec 3, 2007 3:51 pm
We are looking at expanding our inpt. Palliative Care Services to the Outpatient setting. Is anyone aware of the billing requirements for Medicare/Medicaid? Will they pay for OP Palliative Care? What credentials does a RN need to able to bill?
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Re:outpt. billing (by kkerr on 12/06/2007)
Very exciting that you are expanding! As to billing requirements, palliative care programs with an ambulatory outpatient component use standard approaches to fee-for-service billing for outpatient services for physician and non-physician services. So, while an NP could bill for a patient visit, an RN could not. There is a nice write up of professional fee billing issues in the on-line CAPC manual – here is the URL for the page on outpatient reimbursement, which has links to info about MD and non-MD billing.

http://64.85.16.230/educate/content/elements/financingpcambulatorycare.html

Its been our experience at UCSF that there is nothing different about the requirements for a visit to an outpatient palliative care clinic vs. a visit to any other clinic. Best wishes for your planned growth. Kathleen Kerr, UCSF Palliative Care Leadership Center.
+ Re:outpt. billing (by tcousounis on 01/23/2008)
Kathleen's suggestion to refer to the CAPC manual is a good one. Medicaid requirements for physician or NP outpatient visits vary, of course, from state-to-state, so you'll want to research your state's particular requirements.
As for Medicare, you'll want to keep a very close watch on your receivables of your outpatient visits - palliative care physicians across the country have experienced higher-than-expected denial rates for professional service billings.
Tim Cousounis, MDvantage Palliative Care Group

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