Clarifying Guidelines For Medical Billing Cardiac Rehab

Clarifying Guidelines For Medical Billing Cardiac Rehab

Difference in medical billing manuals have made cardiac rehab claim submission confusing. There are three manuals that give guidance on how to bill for cardiac rehab services. These manuals are the Medicare Coverage Issues Manual, Intermediary Manual, and Hospital Manual. Each on of these manuals gives a different method on how to bill for cardiac rehab. The Office of Inspector General realizes that this has become a major medical billing issue.

Recently, an audit was done on thirty four different hospitals. The goals was to see where the consistencies and then confusion lie in billing for medical cardiac rehabilitation. The results were astonishing! There were so many different methods of billing for this service, that it blew the Office of Inspector General’s mind. Some hospitals pinpointed a certain doctor to provide supervision of the rehabilitation services. Others left the supervision up to emergency physicians and “code teams”.

Another difference in the cardiac medical billing patterns dealt with the incident-to category. Some hospitals billed as incident-to the hospital physician’s services. Others billed as incident-to the patient’s referring physician when actually performed by a non-physician.

After this medical billing study was conducted, the Office of Inspector General realized there was a major problem. The agency decided to make it their priority to clarify and educate medical billers and physicians on the proper billing methods for cardiac rehab. At this point, it doesn’t seem like anyone knows what is the correct way. All manual writers will have to get together and come up with a solution.

Medical billing can be a confusing processes. Manuals with differing procedures makes the process all that much more difficult. Medical billing should be left up to trained professionals that know the ins and outs of the business.

View all Articles by: Melissa Clark, CCS-P