EKG's in MFM office

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I was just hired by an Maternal Fetal Medicine physicians office. I do have prior OB/GYN Experience and have come to realize that MFM is just a tad different because they primarily deal with more complex pregnancies. My provider just informed me that he is planning on conducting EKG's in the office with them being read by an cardiologist for a flat rate. He states he is having to refer patients out frequently for those EKG's to be conducted at an cardio, family physician or hospital.

My question is would there be some kind of compliance issue with this? Do you think that it would be cost effective and bring in a little more revenue?

Thanks
 

thomas7331

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This kind of arrangement with an outside physician to read tests is possible. There are some compliance issues that do need to be taken into consideration, namely the anti-markup statutes. For a CMS perspective, you may wish to start by reviewing section 20.3 of Chapter 13 of the Medicare Claims Processing Manual (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c13.pdf), which outlines the billing and payment rules for this. But since this is an area of some legal complexity, and since other payers may have additional requirements that come into play, it would probably be best to have the practice attorneys review any official arrangements before proceeding.

Your second question as to whether or not this would be cost-effective is a little harder to answer and of course will depend largely on how much the practice will be paying the cardiologist for this service and how much your various payers will reimburse you. EKGs bring a very limited reimbursement per test from most payers, and the cost of performing these and then billing them, plus the follow-up and denial management, collecting patient share, etc., added to the amount you are paying the cardiologist, could easily eat up more resources than the small amount of extra revenue that would be brought into the office, so it may not be cost-effective unless your office is able to very efficiently integrate this service into your existing processes. On the other hand, it may be worthwhile to have the additional convenience for the provider and patient even if it ends up costing the practice a little.

Hope this may help some.
 
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