Wiki Provider reimbursement

bethb

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Current question brought to my attention:

Group practice employs Drs. A and B

Patient sees Dr. A for skin condition. Dr. A provides office visit(s) and suggests ultraviolet light therapy for skin condition.

Patient has light therapy on one particular day when Dr. A is not in the office location. Dr. B is the physician in the office location on the day the patient receives UV light therapy.

Dr. A is stating the claim should be billed under her as the billing and servicing provider so she obtains the revenue. Thought philosophy is that Dr. A normally treats the patient and therefore is entitled to the revenue.

My thought philosophy is that the provider who was physically at the office location at the time of the UV light therapy should be the billing and servicing provider. In this case Dr. B would receive the revenue because Dr. B was in the office at the time of service.

Anyone out there have any thoughts?

Thanks!
 
This falls under incident to rules. The supervising/billing physician must be in the office suite at the time of the treatment. This is regulatory guidance, available on the CMS website under "incident-to billing". CMS watches this carefully. If she wants the revenue, she'll need to be in the office.

You're right.
 
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