Wiki Billing for Inpatient Visits as a Covering Physician

[CFINDLING]

Our OBGyn physicians are recently being asked to cover for one of the other OB Gyn physicians in town, what is happening is the physician will deliver the patient and then leave town asking our physicians to cover. Then our physicians are going to the hospital to see these patients, but the patient will return to their regular physician for post partum care in the office. So basically the only service my physician's are providing are the inpatient visits. I think that our physicians should be able to bill for those visits, is that correct? Any specific modifier that they should be using on those codes?

 

[thomas7331]

This is a question you should put to your physicians or your practice manager. Your physicians should coordinate with the physician for whom they are covering as to how they want to handle the compensation arrangements in a situation like this. If the physician who performed the delivery is billing a global code and your physicians are just performing routine post-operative follow-up care or care that is part of a global maternity code that has been billed, then your physicians should not be billing separately since the primary physician has already billed for these services. If that is the case, this physician needs to compensate your physician directly, unless they choose to cover each other at no cost as a professional courtesy. On the other hand, if the expectation is that each physician will bill their own services, then you need to ensure that the physician performing the procedure is billing the appropriate codes and modifiers so that when you submitting your inpatient visits you are not double-billing the patient or payer for services already compensated.

 

[csperoni]

Thomas is correct - this is more of a management issue than a billing/coding issue. But the managers need to understand the billing/coding aspect.

From my experience, usually smaller ob groups and solo practice docs will have a reciprocal arrangement with another small group/solo practice. Alternating weeks, alternating every 2 weeks, or something along those lines. Since the patient's physician is billing global, covering docs do not bill anything.
Larger groups have enough clinicians within the practice to cover each other.
Separating out the billing is possible, but usually gets so convoluted (and you really have to be careful about what the other doc is billing) that both physicians realize covering each other without billing is best. Sometimes Dr. A sees an extra 6 patients a month, sometimes Dr. B sees an extra 6 patients a month. Unless one practice is much busier than the other, it all balances out. There are some practices that will pay the covering physician group a flat rate per day/week, etc. if it's not reciprocal.