If you are one of the many eligible professionals (EPs) that admit to the hospital, read on.
Medicare RAC (recovery auditors) have begun sending re-coupment letters to providers who do NOT discharge their patients.
The Medicare policy prohibits physicians from different specialties from admitting and discharging patients in the hospital setting.
In other words, if you are a family practitioner that admits, you cannot have a practitioner from a hospitalist group discharge your patients.
Many times, a practitioner who specializes in Family Medicine will admit their patient to the hospital and a surgeon will discharge the patient or turn it over to a hospitalist for medical management in the post operative period. This practice is no longer reimbursable. If you admit your patient, according to Medicare, a practitioner of your specialty MUST discharge that patient or no payment will be made.
According to the Medicare Claims Processing Manual “Only the attending physician of record reports the discharge day management service”. In other words, different providers who are members of the same group practice can admit and discharge but only if they are enrolled in the same specialty. To read the regulations and guidelines regarding this, please see the Medicare Claims Processing Manual, Chapter 2.
One more thing to be aware of:
If you are a physician of a different specialty, you must use a subsequent hospital care CPT (99231-9233) for the final visit.
As more RAC alerts become available, I will make the information available here.