Control Denials

May 1, 2004

Can a hospitalist trained in internal medicine and a pulmonary consultant within the same practice and corporation and with the same tax ID number see and bill for the same patient on the same day?

Question: Can a hospitalist trained in internal medicine and a pulmonary consultant within the same practice and corporation and with the same tax ID number see and bill for the same patient on the same day?

Answer: Technically, you can bill it and get paid if the physicians are registered under these specialties. I say this because some physicians return for fellowships and fail to inform Medicare that they are now specialists. If Medicare doesn't have the pulmonologist listed as such, the claim will not be paid.

And in reality, even if the specialist is registered, claims such as these are often kicked out of the carrier's computer system, with one of them denied. (That's why I say "technically.") But if you resubmit with a letter emphasizing the two different specialties, the medical necessity of both (i.e., the positive impact on the patient's care), and attach the consult request and/or documentation of the visit, you should get paid.

Frankly, I would suggest that you consider printing all of these claims to paper, and submit the supporting documents with the original claim. That way, you're more likely to get paid on the first shot. Practices often do this with "strange" billing, like experimental surgeries, two office visits on the same day, workers' compensation claims, and so forth. Instead of waiting for the denial, they anticipate it, and try to get to a human before the computer spits it out.