decisionhealth Newsletters, Answer Books - 2008 Issue 5 (May)
Medicare_Carriers_Manual / 2020 / 2020._PHYSICIANS_SERVICES
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Article Overview
This article explains a Medicare manual policy section on physician services and related billing coverage concepts. It covers the broad categories of professional services, telephone-related services, consultations, patient-initiated second opinions, concurrent care, claim-form completion, and care plan oversight. It is useful for clinicians, coders, billers, and compliance staff who need to understand how Medicare frames these service types and where related guidance is referenced elsewhere in the manual.
Why This Topic Matters
Understanding this section helps readers determine whether a physician encounter or related activity falls within Medicare’s broad coverage framework and where separate guidance may apply. It also clarifies the scope of services discussed across multiple subsections of the manual.
Article Sections
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Ed. Note: For further information see:
Cross-references to related manual chapters and topics that provide additional guidance on adjacent physician-service issues.
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2020. PHYSICIANS’ SERVICES
A general policy section describing the overall Medicare framing of physician services and the major service categories discussed in this chapter.
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A. General
General coverage principles for physician services, including the setting and manner in which services are considered performed by a physician.
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B. Telephone Services
Policy discussion of physician and beneficiary telephone interactions and how they are treated within Medicare payment concepts.
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C. Consultations
Coverage and documentation considerations for consultations furnished by a second physician at the request of the attending physician.
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D. Patient-Initiated Second Opinions
Policy discussion of patient-requested second opinions tied to surgical and other major procedures, including related diagnostic evaluation concepts.
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E. Concurrent Care
Guidance on circumstances in which more than one physician is involved in active care and how concurrent services are evaluated at a high level.
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F. Completion of Claims Forms
A brief policy note on physician charges associated with completing certain claim or billing forms.
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G. Definition Of Physician For Care Plan Oversight Services
Definitions and general care plan oversight concepts for physician supervision in home health and hospice contexts.
What You Will Learn
- How Medicare frames the broad category of physician services
- What types of physician-to-patient or physician-to-family telephone-related services are discussed
- How consultations and second opinions are addressed in the manual
- How concurrent care is described at a policy level
- What the section says about claim-form completion and care plan oversight references
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physicians and physician office staff
- Health information management professionals
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