Common use of Billing Guidelines Clause in Contracts

Billing Guidelines. The HSC includes a review of the patient’s relevant history, relevant family history and relevant history of present complaint, and a review of any laboratory data, PACS images, medical records or other data as needed to provide advice. The health service includes a discussion of the relevant physical findings as reported by the referring provider. The Consultant Physician HSC is not reportable in addition to any other service for the same patient by the same physician on the same day. The Referring Physician HSC may be reported when the communication with the consultant physician occurs on the same day as a patient visit -or other service. The HSC is not reportable when the purpose of the communication is to: - Arrange transfer - Arrange a hospital bed for the patient - Arrange a telemedicine consultation - Arrange an expedited face to face consultation - Arrange a laboratory, other diagnostic test or procedure - Inform the referring physician of the results of diagnostic investigations - Decline the request for a consultation or transfer the request to another physician The service is reportable only when the communication is rendered personally by the physician reporting the service and is not reportable if the service is delegated to another health professional such as: - Nurse practitioner - Resident in training - Clinical fellow - Medical student The service is not reportable for telephone calls or face to face conversations of less than 5 minutes of two way medical discussion. • The referring physician must document that the referring physician has communicated the reason for the consultation and relevant patient information to the specialist. • Both the specialist consultant and the referring provider must document the patient name, identifying data, date and encounter time in their respective charts or EMRs. • The names of the referring physician or provider and the consultant physician must be documented by both physicians. • The diagnosis, reason for referral, elements of the history and physical as relayed by the referring provider, the opinion of the consultant physician and the plan for future management must be documented by the referring physician and the specialist. • A written report must be sent to the referring provider by the specialist consultant. • The referring physician’s billing number must be noted on the claim from the consultant. This is not required for the referring physician’s claim.