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Concurrent care coverage by Medicare.

H A Thompson

    Texas Medicine
    |October 1, 1989
    PubMed
    Summary
    This summary is machine-generated.

    Medicare concurrent care involves multiple physicians treating one patient. Understanding specific modifiers like X6 and documentation guidelines is crucial for Medicare reimbursement, especially for specialists and during acute episodes.

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    Area of Science:

    • Health Insurance Policy
    • Medical Billing and Coding
    • Healthcare Administration

    Background:

    • Medicare is a federal health insurance program for the elderly and disabled.
    • Understanding concurrent care is essential for proper Medicare reimbursement.
    • Texas Medicare carrier provides educational programs for improved understanding.

    Purpose of the Study:

    • To clarify Medicare guidelines for concurrent care.
    • To explain the use of modifiers for specialists.
    • To guide physicians in avoiding claim denials.

    Main Methods:

    • Analysis of Medicare policies regarding multiple physician services.
    • Explanation of modifier usage for specific medical specialties.
    • Guidelines for documentation to support medical necessity.

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    Main Results:

    • Concurrent care requires careful documentation, especially for specialists.
    • Modifier X6 is used for certain specialties lacking direct Medicare designation.
    • Coverage for concurrent care depends on physician specialty and the acute nature of the episode.

    Conclusions:

    • Proper use of modifiers and documentation is key to successful Medicare reimbursement for concurrent care.
    • Physicians should be aware of guidelines to prevent denials for "not reasonable or necessary" services.
    • The Waiver of Liability can be used when concurrent care is necessary but may not be covered.