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Billing Provider Privileges vs Attestation MD and Billing

Kelly Posted Tue 18th of December, 2018 15:10:00 PM
Hello, We have an account where the patient was seen by a resident who does not have privileges at our hospital. Can we bill insurance company under the provider who signed the attestation? This MD is credentialed with privileges for our hospital. Please provide MCR/MCD/Teaching guidelines to support the answer provided Thank you!
SuperCoder Answered Wed 19th of December, 2018 08:11:05 AM

Hi Kelly,

 

Merry Christmas! and thanks for your question.

 

Our experts are working on this. Thanks for your patience.

 

Thanks

SuperCoder Answered Thu 20th of December, 2018 06:21:45 AM

Hi Kelly,

 

Thanks for your patience.

 

Here are the requirements for services to be covered as physician services when a resident furnishes services not related to their training program and furnishes such services outside the facility where he has the training program. When all of the requirements are met, the services are considered furnished in the resident’s capacity as a physician, not in his capacity as a resident.

 

The requirements are:

1) The services are identifiable physician services, the nature of which require performance by a physician in person and contribute to the diagnosis or treatment of the patient’s condition

2) The intern or resident is fully licensed to practice medicine, osteopathy, dentistry, or podiatry by the State where the services are performed

 

Claims must include one of the following modifiers:

1) GC -This service has been performed in part by a resident under the direction of a teaching physician

2) GE -This service has been performed by a resident without the presence of a teaching physician under the primary care exception

 

Both teaching physician and resident may document physician services in the patient’s medical record. The documentation must be dated and contain a legible signature or identity and may be completed using one of these methods:

1) Dictated and transcribed

2) Typed

3) Hand-written or

4) Computer-generated

 

You may read more on following CMS link : https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Teaching-Physicians-Fact-Sheet-ICN006437.pdf

 

Please feel free to write if you have any question.

 

Thanks.

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