Wiki Radiology Reads Question "HELP"

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Candice_Fenildo

Candice_Fenildo

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Hello to all the smart and talented women out there :) And PETA too.

If a physician owns an MRI and performs the test in his/her office, can he hire a Radiologist and pay per scan and then bill the MRI Globally to Medicare?

If so, can you cite a reference to that?

I have read Chapter 13 of the Medicare Claims processing manual and have read chapter 1 as well.


HELP PLEASE :)
 
Last time I checked Candy, you could not do that unless it was a commercial payer. On our Medicare patients we bill the technical portion of the bill and the radiologist bills for the professional. Can't remember the source right now, but it has something to do with the performing provider having to bill under the same corporate NPI and, of course, a per click radiologist does not. When I get a few minutes I'll look for that reference for you.
 
Here is a good reference. It's dated but it's the most relevant I can find.
It supports Barbara's answer very well.
http://www.thehealthlawpartners.com/lawyer-attorney-1410863.html
Here is another good one
http://www.healthlawyers.org/Events/Programs/Materials/Documents/PHY10/reisz_tankersley.pdf

Of note, if the pts receiving these are not the practices pts (ie they are being referred in) and the number of these referred in pts are the substantial amount of the practices volume then the practice needs to register as an IDTF.

Hope these help.

Nothing like researching Starke Law at 3am :)
 
Thank you guys. I am wondering if this is State Specific.... I ask this because there are ALOT of radiologists that advertise fee for service reads. They also advertise to physicians that the ordering MD can bill the insurance company for the entire MRI and pay the radiologist below the Medicare allowed amount for the PC.

Hmmmmm.. Thanks for the resources Peter and Thank you Barbara for the email with the Medicare reference.

I will close this thread now. :)
 
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