General billing questions – Medicare inpatient visits


What does the physician bill when admitting a patient as an inpatient from observation?

Medicare payment for the initial hospital visit includes all services provided to the patient on the date of admission by that physician, regardless of the site of service. The physician may not bill initial observation care or observation discharge management for services on the date he or she admits the patient as an inpatient.

Is it a requirement to document the past, family, and social history (PFSH) for subsequent in-hospital visits?

For the categories of subsequent hospital care and subsequent nursing facility care, the current procedural terminology requires only an "interval" history. It is not necessary to record information about the PFSH.

Will Medicare make payment for more than one initial hospital visit during the same admission performed by providers of the same specialty but different group practices?

No, Medicare does not reimburse multiple visits to providers of the same specialty within the same and/or different group practices. Medicare will reimburse multiple visits to physicians from different groups and different specialties, or physicians of different specialties within the same group practice.

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