Forum - Questions & Answers
H&P prior to admission date
How do you bill when the admitting physician sees the patient late in the evening but the actual hospital admission does not occur until the next calendar day? For example, patient seen at 11PM. Physician does all the work of an initial hospital service (99221-99223) and orders the patient to be admitted as in-patient. By the time the paperwork is done and the patient is on the floor, it is now 1AM the next day which is the date the hospital uses as the admit date. We are getting denials from the insurance companies and are not having any success with appeals. Any suggestions?
Cheryl
Initial face to face
The initial face-face encounter is the date that for 99221-99223 for physician billing. What are the denials for?
H&P Prior to Admission Date
The denials are for DOS prior to admission. We have not had success with appeals. Some of the clinics are using a clearinghouse, and the claims are being stopped from even transmitting because the DOS is prior to the hospital's documented admission date.
Initial service
Payers often consider the hospital recorded date of admission to be admit date. If not an inpatient at 12 midnight, then the date of admission for physician would be date patient actually ordered as an inpatient, which could be 2nd date overlapping.
Officially
The date and time of admission is the date and time that the admission order was written by the doctor and the hospital should be using this date and time. If they are using the time that the patient arrives on the floor then they are wrong (and losing money since a day starting at 11 pm is reimbursed the same as a day starting at 1 am).
You should talk to the hospital billing dept about this.
I am surprised that the clearinghouse knows what date the hospital submitted to the insurer as the admit date.