Billing for service performed at another hospital

RHirsch

Medicare FFS patient. Inpatient at hospital A, sent to hospital B for a specialized procedure and sent back to hospital A to continue inpatient care. By regulation, A will bill the whole stay as one admission and include the procedure performed at B on the claim (as if they did it). B will bill A for the service. 

I know this is the regulation but does it work in real life? How does A know how to code the service? How does A decide how much to pay B? How do the billers at B know to send the bill to A and not to Medicare?What if the patient spent a night at B recovering? Does that affect how much B gets paid? 

thanks!

trinker

We do follow this process in real life.  When we send an IP to another facility, we ask that they list our facility as the guarantor.  We still expect a properly coded claim to be sent to us.  We have several facilities within our Network.  We have agreed to accept Medicare payment rates as payment.  We have also received patients from a local competitor hospital when their CT or MRI machine was down.  We have had a gentleman's agreement to accept Medicare rates.