How should we bill New York Medicaid when there are providers that are not hospital employees providing services in an emergency department setting? The business model example is the hospital contracts with an independent contractor (i.e., staffing company) to provide services in the emergency department utilizing physicians, nurse practitioners, and physician assistants.
Answer 1: The e MED NY website maintains a Provider Manual to the New York Medicaid Program that includes billing guidelines for physicians and nurse practitioners. There are other questions that also need to be considered. For example, is the emergency department provider staff part of a faculty practice?
This question was answered by: Caswell Samms, III, vice president and CFO, WellStar Kennestone.
Answer 2: At my last position, we had a private company providing emergency department physicians and the billing was no different than here at Methodist where the emergency department physicians are salaried. The private company billed the professional component and the hospital billed the technical. There is no issue 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.
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