Have Some Extra Cash You'd like to Send to the Government?
December 4th, 2014 - Betsy NicolettiNo it isn’t tax time. But failing to follow Medicare rules when submitting claims could result in a paycheck for Uncle Sam. In fact, you could have to return money that you've already collected from the government. I know three practices that have done that this year, and all for the same reason. What was the reason? Billing for student services. What kind of students? Nurse practitioner and physician assistant students. Students are not licensed and enrolled in Medicare or in any other third-party insurance company and you may not bill for their services.
Some groups think that if the supervising mid-level provider countersigns the note, or indicates that they saw the patient as well and agreed with the student’s assessment and plan, that they can bill a service under the supervisor’s provider number. Nothing could be farther from the truth. Student services are never billable. It doesn't matter if the student is a medical student, a PA or NP student, or a physical therapy student or the smartest, brightest, most promising student in the world. You cannot bill for their services.
But groups want to have students involved in the care of their patients. As a service, they like to take a PA student or an NP student to give those students practice experience. If they do this, only the service provided and documented by the licensed mid-level provider may be reported. A student may document what a staff member may document, which is the review of systems and the past medical, family and social history as long as there's evidence that the billing provider reviewed this. Most practices want the student to have a fuller experience. I agree with this. Allow the student to see the patient and document the service. However, the supervising clinician must see the patient, examine the patient and document the work performed. When submitting a claim for this service, base the claim only on the work done by the licensed professional and the note documented by that professional.
Student services are never billable. Unless you want unless you want to send money back to Uncle Sam, don't make this mistake.
###
Questions, comments?
If you have questions or comments about this article please contact us. Comments that provide additional related information may be added here by our Editors.
Latest articles: (any category)
Artificial Intelligence in Healthcare - A Medical Coder's PerspectiveDecember 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities?
Specialization: Your Advantage as a Medical Coding ContractorDecember 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike AgainDecember 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for AppendicitisNovember 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M ServicesOctober 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....
