General Question for the Week of April 3, 2017

Question:

Can hospitals bill Medicare for the lowest level ER visit for patients who check into the ER and are “triaged” through a limited evaluation by a nurse but leave the ER before seeing a physician?

Answer:

No. The limited service provided to such patients is not within a Medicare benefit category because it is not provided incident to a physician’s service. Hospital outpatient therapeutic services and supplies (including visits) must be furnished incident to a physician’s service and under the order of a physician or other practitioner practicing within the extent of federal and state law. Therapeutic services provided by a nurse in response to a standing order do not satisfy this requirement.