Nursing home charges on same day patien is admitted in the hospital

Patient living on the nursing home, after primary pcp Dr. visit, the covering Dr. in the hospital admits the patient, can we bill for both services?

Please clarify?

Can you clarify this a little? it sounds like there is more than one doc involved? Are you billing for more than one doc?

Typically each doc will bill his/her service regadless of what went on with another doc even if they are the same specialty (unless they belong to the same group)

But if one doc did both visits, you would only code the admit.

Nursing home admission after PCP visit

Although both doctors can bill for the service, I believe only one will be paid if they are of the same specialty, whether they are of the same specialty or not. If they are in a group, and of the same specialty, then certainly only one is paid.

If the primary care doctor saw the patient and a cardiologist admitted the patient (unlikely, I know, just an example) I think you would have a chance to get both paid. But, in the situation you describe, I think the claims editing systems will see two E/Ms on the same day, and pay only one.

Communication is key to this situation

This happened a lot in my practice. The doc who saw the patient in the nursing home should send the patient to the hospital with admit orders and call the hospital-covering doc and sign out the patient, telling the doc to do the H&P the next morning, within 24 hrs of arrival in the hospital. Of course if the patient is critically ill or unstable then they have to see the patient on arrival but that was infrequent. And in that case the nursing home doc did not bill for the visit and left the order writing and evaluation to the hospital doc (the level 3 H&P is better reimbursement than the SNF visit)