Wiki Co-management

[LRizzitano]

The ophthalmology office I work for does some co-management with some local optometrists. One of the offices uses a billing agency and is having some difficulties with these claims and has ended up not getting paid and giving up on a couple of occasions due to the cost of resending the claims and the amount of the reimbursement. Is it legal for us to bill the surgeries without the co-management modifiers and just give them a check for what the 20% would be??

Thanks

 

[Kristen Bensel]

I would not recommend doing that- if the optometrist office is doing the postoperative care, then they should be billing and get the reimbursement that way.
I am more curious if the billing agency is billing correctly. We do co-management with a few ophthalmologist for cataract surgery and I know that there is very specific information that has to be on the claim to receive reimbursement. Medicare requires the postoperative visit for the optometrists office to be mirror the surgeon's claim (Date and all) with the exception of the modifier. The co-management provider should use modifier 55 instead of 54 like the surgeon's office, and the claim must include the date of transfer.
Private payers do not require the date to be the same, but still need the same modifiers as medicare as well as the DOT dates.

 

[LRizzitano]

I understand this is not the ideal. We co-manage with other offices without an issue. If it is a matter of no longer doing co-management with him due to his "administrative headaches"as he calls it .... Is it legal???