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Accounts for medical fees must contain particular information for a Medicare benefit to be paid - Relevant Provision6.

Accounts for referred services must contain the date on which the service was given and the date on which the patient was referred - Relevant Provision7.

Referrals must be made in accordance with the regulations - Relevant Provision2.

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While all of these may be routine functions of the local Medicare carrier or even CMS’s national office, physicians must be aware that any one of them can be an indication that their practice activities are under scrutiny.

With the Medicare recovery audit contractors moving full speed ahead, they will be searching to recovery billions of dollars of inappropriately paid claims with an emphasis on hospital billing practices.

One issue they will be looking carefully at is whether the inpatient status or observation status was paid appropriately and that's where code 44 becomes applicable.

A referral covers a single course of treatment for a patient, being - the initial attendance by the specialist or consultant physician; - the continuing management/treatment until the patient is referred back to the care of the referring practioner; and - any subsequent review of the patient’s condition that occurs within 9 months after the period of validity of the last referral - Relevant Provision 4.

The period of validity of referrals is clear and can be managed by the practice without exposing the referring practitioner, specialist or consultant physician to penalties - Relevant Provision5.

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