Please read and open Meditech BAR task if this pertains to your facility as well.....
We have a billing/compliance issue with our 1500 claim programs that Meditech states they do not wish to address because we are the first to identify the issue and only client complaining currently. I am surprised this has not come up as an issue in the past with other Meditech clients. I opened the following issue up with Meditech and they do not wish to change the claims program for the 1500 to address the issue because no other clients have complained. Do you have this issue? How do you handle billing for a physician procedure that was performed by a different physician other than who ordered ? The NHIC as well as CMS instructions also states that when a claim involves multiple referring and /or ordering physician (field 17) A separate form shall be used for each ordering/referring (field 17). We now have a Hospitalist group here and there could be different ordering physicians each day for the patient who are not listed as the attending physician on the account. The way the claim program works now is it only prints a new claim per change in performing not referred as well as performing as stated in the requirements above. The claim program also only pulls in the Attending physician in Field 17 rather than the Ordering physician. The ordering physician is available in BAR.PAT but the claim program does not reference it at all. Due to the major programming needs to accommodate the billing regulations Meditech is expressing no desire to correct this issue, which leaves us with no options to correct this issue. Billing instructions listed below that I used to open the task with Meditech. If you would like to cut and paste to open the same request for your facility it would be helpful since they feel one client is not enough to warrant the major claim program. According to the NUCC instruction manual and the MCR (NHIC) BILLING MANUAL Field 17a and 17b is required when a ordered or referred by physician is different then the performing/rendering physician (field 24J-NUCC FORM OR 24K OLD FORM). Field 24j/24K should show the rendering physician which it is. It is currently showing the performing physician that is entered when the charge is entered. This field should be supplied at charge entry and is stored in the BAR patient data file as @txn.perf.physician. Field 17 a must be reported when a service is ordered or referred by a physician other than the performing physician. This field would equal the ordering physician on the charge. This field should be supplied at charge entry as well and is stored in the Billing patient data file as @txn.ord.physician) The NHIC instructions also states that when a claim involves multiple referring and /or ordering physician (field 17) A separate form shall be used for each ordering/referring (field 17). The claims in Meditech are currently printing separate claims based on field 24k the performing physician. In short the changes will be necessary to meet these requirements: 1. We will need to be able to pull in the txn.ordering physician in field 17& 17a-b if there is one otherwise leave blank. This is not a required field even though it is what is driving the separate forms rule. It is only required when the ordering physician is different from the rendering provider in field 24 2. Fields 24j & or 24k is pulling in the @txn.performing physician as it should. 3. A separate claim should print based on the performing physician as it is now, except if there are charge item lines with that claim in section 24 that have different ordering physicians we need separate claims as well. Marie Johnson Financial Application Support /Report Writer Northern Berkshire Health Systems 71 Hospital Avenue North Adams, Ma 01247 Phone: 413-664-5253 Fax: 413-664-5322. email: [EMAIL PROTECTED]
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