Forum - Questions & Answers

Aug 10th, 2009 - Khatchig 6 

72 hour rule for medicare

I am confused.
If a doctor works and sees a patient in a hospital's outpatient clinic examines and evaluates the patient , performs several tests and sends him for admission to the hospital, I understand that E and M and the services done within 72 hours of surgery or admission will be bundled with the inpatient services. Am I correct? What happened to the E&M and time he spent with the patient ? will he be reimbursed by the hospital ? how does it work. With a sallary from the hospital and without if such thing exists.

Aug 10th, 2009 -

You misunderstand the rule

As we often see here, the misunderstanding relates to who is billing- the doctor or the hospital. Hospitals have to bundle any services provided to a patient prior to an admit into the DRG for the admission (don't know the hour guideline).
For physicians, the bundling is only for surgery, not for admissions. If I see a patient in the office and admit him, I can either charge an office visit or an H&P. For surgeons, the pre-op H&P is bundled into the payment but they can use modifier -57 to indicate the visit was to determine the need for surgery and get paid. That would apply to a patient with appendicitis when the surgeon is called to the ED.

Aug 10th, 2009 - nmaguire   2,606 

72 hour rule

This is a facility billing issue, not a physician.

Aug 10th, 2009 - Khatchig 6 

72 hour rule

Thank you so much, I finally got it, thanks big time.



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