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Physicians covering family members in hospital

Jean Posted Thu 02nd of August, 2012 16:32:30 PM

A Medicare patient is admitted to the hospital by a member of a group. The patient's son is a physician in the same admiting group. The admitting doctor, not related, is the doctor of record. When the son is covering for the admitting doctor and he performs hospital visit on his father, who is also a patient of the group, may the son bill Medicare for his services or do they need to be billed under the unrelated admitting physician? Sorry if this is confusing.

SuperCoder Answered Thu 02nd of August, 2012 17:31:14 PM

Son is not allowed to bill.Here is a paste from AMA

Ethical questions have been raised about physicians who treat members of their own families. Incomplete physical examinations, medical records, and immunizations are undesirable consequences of physicians' treating their own children. The 1901 code of ethics of the American Medical Association (AMA) noted that a family member's illness tends to obscure the physician's judgement and produce patient timidity. In 1989, fearing financial abuse by unscrupulous providers, Medicare barred payment to physicians who care for "immediate family members."

Who counts as a family member? Medicare's list of "immediate relatives" includes spouses, parents, children, siblings, stepparents, stepchildren, stepbrothers, stepsisters, children-in-law, siblings-in-law, grandparents, grandchildren, and spouses of grandparents or grandchildren. Since 1989, Medicare has not paid for patient care charges by immediately related physicians, their associates or their professional corporations. Blue Cross—Blue Shield, which has a stricter definition of "family member," has not paid for these charges since 1976.

130 - Charges Imposed by Immediate Relatives of the Patient or Members of the Patient’s Household(Rev. 1, 10-01-03)
A3-3161, HO-260.12, B3-2332
A. General

These are expenses that constitute charges by immediate relatives of the beneficiary or by members of their household. The intent of this exclusion is to bar Medicare payment for items and services that would ordinarily be furnished gratuitously because of the relationship of the beneficiary to the person imposing the charge. This exclusion applies to items and services rendered by providers to immediate relatives of the owner(s) of the provider. It also applies to services rendered by physicians to their immediate relatives and items furnished by suppliers to immediate relatives of the owner(s) of the supplier.

http://www.cms.gov/manuals/Downloads/bp102c16.pdf Page 29

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