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CAPC Palliative Care Discussion Forum
Billing and Financial

In Reply To: outpt. billing
Next Reply: Re:Re:outpt. billing
Previous Message: Re:outpt. billing

Post Re:outpt. billing
Author: tcousounis
Date: Jan 23, 2008 8:44 am
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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Re:Re:outpt. billing (by SharolHerr on 01/23/2008)
We have not had experience billing for outpatient palliative care but have been very successful in billing for inpatient palliative care. We work very closely with our medicare mediary and with our system billing consultants to assure that our physician/NP billing meets the criteria for the different billing codes. It was helpful when we presented several samples of our documentation to them for critique and review. It affirmed that often the physician would tend to under bill fearing denials. We have found that if we "walk the line" of what they are looking for that denials haven't been an issue. At the CAPC Seminars and at the Palliative Care Leadership Trainings there is time devoted to guidelines for billing successfully. I'd encourage new billers to also explore the resources on the CAPC Website. Sharol Herr, RN, MSEd Nurse Clinician/Education Coordinator Mount Carmel Health Palliative Care Services Palliative Care Leaderhip Centers Columbus, OH

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