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CAPC Palliative Care Discussion Forum
Billing and Financial
Re:Re:Hospice Physician and Private Insurance PatientsDate: Mar 19, 2008 3:44 pm
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| Re:Re:Re:Hospice Physician and Private Insurance Patients (by Weissman on 03/19/2008)
Let me clarify my last post regarding Hospice Billing--I forwarded the question to Dr. von Gunten for comment--he provided the text and was referenced at the bottom.
David E. Weissman, MD
Professor & Director of Palliative Care
Medical College of Wisconsin/Froedtert Hospital
Palliative Care Leadership Centers
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| Re:Re:Re:Hospice Physician and Private Insurance Patients (by Weissman on 03/20/2008)
I sent your message to my billing specialist in Wisconsin--her reply is below--I hope this is helpful:
I am not familiar with the specific NC state laws affecting PA's, so my answer will be based on Wisconsin law and basic Medicare Part B rules. First, CMS Intermediaries do not process claims for physician/provider services. CMS Medicare Carriers do. The Part B Carrier that services North Carolina is CIGNA (Connecticut General Life Insurance out of Nashville Tenn.
To answer the question, the physician has to be within shouting distance only if the service will be billed "incident-to" or under the physician's name. That is where the compliance risk is. Depending on North Carolina state law, the physician practice itself, location of service, etc., the PA may be able to work under the "general" supervision of the physician (physician available by modern telecommunication techniques) but must bill under their own name and number to Medicare and take a 15% reduction in the Medicare fee schedule. It is the 15% reduction that often steer medical practices away from PA's/NP's contribution to the practice. That or the practices do NOT understand the "incident-to" guidelines and implement them effectively.
The bottom line is get familiar with those local/state guidelines and seek expert advice.
David E. Weissman, MD
Professor & Director of Palliative Care
Medical College of Wisconsin/Froedtert Hospital
Palliative Care Leadership Centers
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