Wiki Medicare Patient in Rehab Hosp Came to Our Office

[debkidcks]

Our physicians don't go to all of the rehab hospitals in town. Therefore, if a patient from that hospital needs to be seen, he/she is brought to our office and we bill an OV charge with place of service 11. Medicare has done RAC audits on several of these saying we can't bill an OV on an inpatient, and we've appealed sending the OV records and noting on the appeal cover sheet that the patient was brought to our office. Today, we got our first appeal denial from Medicare (with no new information; they just said, again, we "can't bill an OV charge on a hospital inpatient . . . ").

Does anyone know if we just aren't allowed to see rehab hospital inpatients at our office, if there is something we need to do with the billing to avoid the RAC audits, or if we're just stuck billing and appealing? I've looked on the CMS website and found nothing.

Thanks -

 

[Morris73]

I would think the OV would be considered a part of consilidated billing for the rehab, you should be billing the rehab the patient is an inpatient at. I know in cases of SNF's, when I billed for an outpatient clinic, we billed the snf for ov's. Hope it helps

 

[debkidcks]

Thanks for the reply.--

Consolidated billing doesn't apply to physician visits. It's for ancillary services. We've been caught by surprise on a few of those - we've given IV therapy to a few Medicare patients and later found out they were in a skilled bed at a nursing home, so we had to bill the drug and the infusion to the nursing home. Office visits, though, are payable under Part B regardless of whether the patient is in a skilled bed or not.

My question might have answered itself, though - at least somewhat. After my initial post, Medicare paid for another patient's service with the same circumstances. I have no idea what the difference was - maybe the records we submitted were worded just a tad differently - ?

I still don't get it, though. Why would Medicare assume that a rehab hospital inpatient would never leave to see a doctor? The rehab hospitals haven't had any problem with their patients being required to go to a doctor's office instead of having the doctor coming to the hospital.

Maybe in the future we'll try putting a comment on the claim -