Outside Radiologist, our equipment and coding.

[apagano1]

Having a problem getting paid for our imaging billing. We have outside radiology company reading the imaging. They get paid a flat fee through our clinic for every MRI they do. How are we coding the imaging? Are we just billing TC?

 

[SharonCollachi]

I believe that you bill both components, but the professional component is subject to the anti-markup limitation (meaning you get paid the lesser of the fee schedule or the amount you pay - the flat fee). See here for more info: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c13.pdf

I know that these arrangements and allowances have changed over the years, someone else please chime in.

 

[csperoni]

I've only had experience with this years ago. We were paying outside radiologist for sonogram interpretation/report.
After the lawyers looked it over, for commercial insurance our office billed the complete service (and paid the radiologist a flat fee per read). For Medicare, we billed -TC and radiologist billed -26. For some of those Medicare regulations, you may want official advice.