Patient used Part A for ER visit - consolidated billing?

I have a claim (pathology) being denied by Medicare because the patient presented at a hospital ER later in the day and Medicare states they paid the hospital due to consolidated billing.

I have never had this happen previously - only with SNF patients.

I can't find any info on consolidated billing/part A/NON-snf patients. This patient is not in a SNF.

Has anyone else experienced this? Does anyone have an article or a link to CMS/Medicare regarding this situation?

Thanks for any info.

re: Patient used Part A for ER visit - consolidated billing?

I would call the patient or hospital and see if the patient went from the ER to being admitted. If this is the case, it would be the 72 hour ruling you would follow. I'm thinking this is what most likely happened.

re: Patient used Part A for ER visit - consolidated billing?

The 72 hour rule is for facility billing, not physician

re: Patient used Part A for ER visit - consolidated billing?

He wasn't admitted, he was seen in the ER and sent home. We just switched to Noridian and I'm thinking they may be the issue.