General Question for the Week of April 3, 2017

General Compliance Question of the Week


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?


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.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.