Philadelphia Reflections

Letter from John C. Berry Department Health and Human Services.

Department of Health and Human Services Bureau of Program Operations

Mr. George R. Fisher III, MD

Pennsylvania Medical Society

20 Erford Road

Lemoyne, Pa. 17043

Dear Dr.Fisher:

The Administrator has asked me to respond to the Pennsylvania Medical Society proposal on the subject of cross-over billing for Medicare and Medicaid. You described a difference in Pennsylvania between Medicare and Medicaid requirements for identification of individual providers who file a claim(s) for service as apart of a group practice.

After examining the problem, I find that the Medicaid statute requires identification of the individual within the group to produce a profile o care and service for each individual provider and to properly account for payments. Consequently, I must continue to require the identification of each individual provider practicing in a group for Medicaid claims.

REgarding Medicare requirements, we are aware of the different requirements of each program and are working to bring the two programs closer together. HCFA staff is preparing background material and analyses for my consideration. I will be addressing these issues in the near future and hope we can resolve these differences to the satisfaction of all parties.

Thank you for sharing your concern.

Sincerely yours,

John C. Berry

Director

Originally published: Friday, December 14, 2018; most-recently modified: Thursday, May 23, 2019