If the patient is an HMO patient:
The Mental Health Hospital is capped and pays the physician, then
the data would be reported as an encounter by the payer (in this case the
Hospital)
If the patient is a fee-for-service patient:
The physician is an independent practitioner (not contracted with
the Hospital) then the MD submits directly to the 3rd party payer.
Either way, the MD will be paid therefore claims information does pass
hands.
Jan Powell, MBA, RHIA, CCS
-----Original Message-----
From: McCall, Allen [mailto:[EMAIL PROTECTED]]
Sent: Tuesday, February 12, 2002 4:01 PM
To: '[EMAIL PROTECTED]'
Subject: Claim status without a claim
Situation: A Sate funded Mental Hospital takes one of its inpatients to be
treated by a physician for the flu. The physician bills the hospital. The
hospital pays the physician. NO plans/payers are involved.
Issue: This does not meet the definition of a claim because a claim is
defined as between a provider and a plan (see the rule section 162.1101).
But what about a Claim Status and a Remittance Advice?
Allen McCall
Sierra Systems
711 Capitol Way SE, Suite 304
Olympia, WA 98501
Telephone: (360) 357-5668
Mobile: (425) 894-0790
Fax: (360) 754-0480
[EMAIL PROTECTED]
http://www.sierrasystems.com
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