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Back  RFI # 1093: Multiple Attending Providers

Formal vs. Informal Help Informal Formal

Submitter

Jacob Welle

Description

Medicare's 72 hour rule requires a single claim for all diagnostic and related non diagnostic services performed within 72 hours of the admission. In the 5010 Instituional format the 2400 level Attending Provider loop was removed.

Where should the additional attending provider submit on the claim if the 2420C is already submitting an additional Rendering Provider?

Submitter Assigned Keywords

5010 Institutional

Response

This issue is explicitly addressed in guide 005010X223. The claim level loop 2310A for Attending Physician occurs only one time.

There is no service specific attending physician loop or reporting capability.

If there are multiple attending physicians for the various services, then multiple claims are required to report this information.

Section 1.8 states "A trading partner agreement must not override the specifications in this implementation guide if a transmission is reported in GS08 to be a product of this implementation guide."

Therefore, Medicare can't create a reporting requirement that contradicts the guide.

Recommendation

Contact Medicare to determine whether they want to change their requirements to allow multiple claims so that multiple attending physicians are reported or to accept only one claim with the understanding that only one attending physician can be reported.
Submission 6/29/2010
Status Date 6/30/2010
Status F - Final
Primary References
Document 005010X223
SectionD.11
Page577
Set ID837
Table2
Loop2400