Q&A: Charging a call fee to Medicare patients

February 20, 2009
Renee Stantz

Is it legal to charge a modest amount to each Medicare patient that is provided 24-hour coverage?

Q: Is it legal to charge a modest amount (around $25 or $30 a month) to each Medicare patient that is provided 24-hour coverage? Essentially, this would be a call fee. I recognize that this is not a covered service from Medicare's standpoint, and I will not bill Medicare for it. If necessary, I could have patients sign an Advance Beneficiary Notice. Medicare may claim this coverage is included in the visit, yet it does not subtract payments from physicians who do not provide 24-hour coverage. Further, when Medicare conducts audits, it does not provide us with credits for taking care of a patient in the evening, the middle of the night, or on weekends. The payment is based only on the documentation of the visit at the time of service.

A: Unfortunately, the American Medical Association has not created any codes specifically for Part B "on-call" physician services. There are several codes in place (numbered between 99050 and 99060) for services that are provided during holidays, nights, weekends, etc. But Medicare views each of these codes as bundled into the evaluation and management service provided, meaning they are already being paid via the E/M service and cannot be billed separately to the patient. Therefore, a physician cannot give patients an ABN and bill them separately for after-hours visits. Commercial insurance carriers are paying the codes mentioned above more and more, so try billing those codes in addition to the E/M code. Also, some practices have won appeals concerning these codes. One argument you can make is that your physicians are going above and beyond, and if they didn't see the patient, the insurance company would pay much higher costs for the patient to go to the emergency room. Finally, bill the codes to Medicare (with the –GY modifier for items that do not meet the definition of any Medicare benefit) so it can see how often the codes are utilized.

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