ED Coding & Reimbursement Alert - 2004 Issue 2
Physician Notes: Physician Practices Can Merge With Hospitals
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Article Overview
This premium article explains a hospital and physician practice merger/reintegration reviewed in an HHS Office of Inspector General advisory opinion, with discussion of the general compliance issues the arrangement raises. It also covers a Medicare carrier bulletin about the retirement of unofficial HCPCS Level III modifiers and the billing contexts in which they had been used. The article is relevant to coders, compliance staff, physician practices, hospitals, and revenue cycle professionals following Stark, kickback, and modifier-related Medicare guidance.
Why This Topic Matters
It helps readers understand how federal fraud-and-abuse oversight can affect hospital-physician arrangements and alerts billing teams to a modifier change that could affect claim acceptance.
What You Will Learn
- The general compliance issues raised by a hospital-physician practice reintegration arrangement.
- How an HHS OIG advisory opinion relates to fraud-and-abuse concerns.
- Why a Medicare carrier bulletin addressed the retirement of certain unofficial modifiers.
- The types of billing situations affected by the modifier phaseout.
Who Should Read This
- Physician coders
- Hospital compliance teams
- Revenue cycle staff
- Medical practice administrators
- Healthcare attorneys
- Medicare billing staff
Code Ranges Discussed
Modifiers Discussed
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