On-Call Services: Avoid On-Call Fraud Accusations with These FAQs

Torrey Kim
November 29, 2011 — 1,269 views  
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Beware: You can't capture ER coverage services with after-hours codes.

If you bill incorrectly when your physician covers for others -- or when another physician covers for your physician -- you could be setting yourself up for charges of fraud.

Don't stress: Remember just a few simple answers to the top three on-call medical billing questions, and you'll be ready to correctly file claims.

1. Which Physician Bills for the Services?

If your physician is on call and handling patient services for another physician, don't fall into the trap of letting the other physician bill for the services. Even though a patient sees a particular physician, that does not mean that physician can bill for any services related to that patient's care. When your physician provides a service, even while on call for another doctor, you should bill the services.

Check the NPI: Each doctor who sees a patient should bill for the appropriate services rendered, under his/ her own NPI (National Provider Identifier) number.

The key: Whoever sees the patient face to face and documents and signs his/her name should be the one billing for those services provided regardless of who the admitting surgeon is.

2. How Do You Report On-Call ER Services?

Often, physicians see patients in the emergency department while on call. Don't turn to the after-hours codes to bill for these services when the hospital pays your physician for on-call status.

Reasoning: If the hospital is already paying the physician to be the on-call physician in the emergency room (ER), you cannot double-bill for his services. You should bill the after-hours codes 99050 (Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed [e.g., holidays, Saturday or Sunday], in addition to basic service) and 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service) only when your physician sees a patient in your office outside regular office hours andanother third party is not compensating him for his time.

Example: If your office closes at 5 p.m. but your physician sees a patient on an emergency basis at 7 p.m., report 99050 in addition to any other services provided. If your physician saw the patient in the emergency room at 7 p.m., you should not report 99050. Keep in mind: Not all insurers will pay you for the after-hours codes.

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Torrey Kim

Torrey Kim, MA, CPC covers Medicare Coding , billing, and compliance issues in-depth every week as the editor-in-chief of the popular weekly publication Part B Insider (published by The Coding Institute and available on SuperCoder.com). By staying on top of Medicare's many transmittals, webinars, articles, LCDs, and coverage changes, she offers a unique insight into the multi-faceted area of Part B coding. She has been a presenter at several audio-conferences discussing Medicare issues. She holds degrees from Wesleyan University and American University, and is a certified professional medical coder through the AAPC.