Question: How should I bill New York Medicaid for services provided by non-hospital employee clinicians in emergency department settings? For example, a hospital may contract with an independent contractor (i.e., staffing company) to provide services in the emergency department utilizing physicians, osteopaths, nurse practitioners, and physician assistants.
Answer 1: The eMedNY website maintains provider manuals with the billing guidelines for physicians and nurse practitioners. There are other questions that also need to be considered. For example, are emergency provider staff part of faculty practices?
This question was answered by: Caswell Samms, III, vice president and CFO, WellStar Kennestone.
Answer 2: At my last position, we had a private professional corporation (PC) of emergency department physicians and the billing was no different than here at Methodist where the emergency department physicians are salaried. The PC billed the professional component and the hospital billed the technical. No issues as long as the contracts were set up correctly.
This question was answered by: Elizabeth Carnevale, assistant vice president, patient financial services, NewYork-Presbyterian/Brooklyn Methodist Hospital and a member of HFMA’s Metropolitan New York Chapter.
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