Wiki HELP! Ultrasound billing requirements -documentation

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valerieeanderson

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Buckeye, AZ
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Hi guys
I really need some help with finding a resource to show my providers. Here's the scenario:

We are a large Urology group practice. We bill globally for ultrasounds. We own the equipment and the facility and employ a tech and radiologist that perform and do a preliminary interp of the ultrasound. The interp is sent to us and then we bill under the ordering urologist. Our urologist have not been doing any kind of note or documentation of the radiologist report. Can we bill these ultrasounds under our Urologist globally WITHOUT their documentation? If so or not, where is the definitive specific documentation that says that?

I say they need to bill under the radiologist but that radiologist is not credentialed. I feel they can bill the TC portion as is but they want to bill globally, wouldn't they need their own interp to do so?
 
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If I understand correctly, under CMS rules you can bill globally if your physicians have contracted with the radiologist to perform the interpretation, however, your radiologist must be credentialed with Medicare.

A physician or other supplier that provides diagnostic tests may bill and receive the Part B payment for the TC or PC of diagnostic tests which that physician or other supplier acquires from another physician, medical group, or other supplier.... [T]he performing physician or other supplier must be enrolled in the Medicare program.

This is addressed in the Medicare Claims Processing Manual, Chapter 13 - Radiology Services and Other Diagnostic Procedures, Section 20.3.2 - Billing for Services, beginning on page 10 of the link below:

 
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I think you double posted this question, and I posted my answer in your other post before seeing Thomas' answer above.

I will say upon reading the CMS rules, the urologist can bill globally as they are part of the same practice. The AIUM and AUA guidance stated -26 by the interpreting provider. CMS seems to make it more broad, to allow groups to bill global.
 
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