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Billing and Finance

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Post NP billing in inpatient setting
Author: dawnwold
Date: Jan 8, 2010 2:43 pm
We have a palliative care consult service which uses an employed physician, contract physicians, and a NP who is a hospital employee hired to the nursing department. My understanding is that as a hospital employee who is a member of the nursing department this NP can not bill medicare separately because the services are considered part of the "bundled service". Is this correct? And can you recommend sources to back this up? Also if this NP was moved from the nursing department and hired into the physician group affiliated with the hospital could they then bill? We are a not for profit county hospital. thanks, dawn
Replies: order by [Date] [Author] [Subject]
+ Re:NP billing in inpatient setting (by JulieP on 01/13/2010)
I've always understood that providers employed by a hospital cannot bill PartB and that their services are bundled into the faciltiy charge which is billed to PartA (Medicare). If the NP is employed by the hospital I'm doubting that she even has a Medicare provider number in which to bill. I reviewed the CMS Benefit Policy Manual, Chapter 15, section 200 and the Claims Processing Manual Chapter 12 Sections 120 & 120.1 and something in there might be of use to you? If you lease this NP or you employ this NP, you should be able to bill for her services,
Julie Pipke CPC, RM MCW
+ Re:NP billing in inpatient setting (by sjcrump on 01/14/2010)
The problem would be if, as an employee of the hospital, the NP's services were already being reimbursed under the hospital's "cost report" to Medicare (this would be "double-dipping" and illegal). The NP would not need to be employed by the physician group to be able to bill but could definitely bill if this was the case. The following article is offerred to assist:

http://www.medscape.com/viewarticle/705683_2

Posted by Sandra Joyce Crump on behalf of
Eric P. Walker, PA-C
Supportive & Palliative Care and PCLC Faculty at the University of Alabama at Birmingham
Re:NP billing in inpatient setting (by JulieP on 01/15/2010)
I need to re-word my post from earlier this week. The hospital can bill for the NP's services to Part B if they are not receiving payment from Medicare on their cost report. Totally agree with the last poster's comment. In addtion to that, I want to mention that the physicians group cannot bill for the NP's services as the NP is not their employee. While the question didn't state the physicians wanted to bill fot the NP directly, that is the direction I was initially taking.
Julie Pipke-CPC, RM MCW

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