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Radiology contract agreement

  1. #1
    Question Radiology contract agreement
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    If an IM practice had a contract agreement with an outside radiologist to read and perform a report for each x-ray, wouldn't the IM practice still bill out the rendering global service under the radiologist name not the ordering IM physicians name? If you bill the gobal service under the IM physician name than it would look like that IM physician rendered the service. The radiologist doesn't have to be an employee of the practice since they have a contract but wouldn't the radiologist have to be credentialed under the participating insurance carriers that the practice is under the practice's tax id since the radiologist is rendering the service? And articles or advise is needed!

  2. #2
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    My understanding has always been that if you have a contract with the outside radiologist and you are paying him/her for the overread, you bill the global service. The radiologist can't bill for the professional component because they are already being paid for the read.

    Someone please correct me if I am wrong here, but that has always been my understanding.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  3. #3
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    If you billed the gobal service would you bill it under the ordering physician's name or the radiologist who read the report?

  4. #4
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    I agree with Dawson and I would think you bill out under the IM practice and not the contracted radiologist.

  5. #5
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    If the payer doesn't allow pass-through billing, you may not be able to bill for the portion that they rendered. Bill the professional component IF your doctor does the interpretation. You can only bill the technical if you own the equipment, I believe, but I could be wrong about that. Check into the specific payer policy - if you can't find one, Google it. You'd be amazed at how much easier it is to find some coverage policies that way.

    Also, some insurers are SUPER picky about what specialties are allowed to bill certain radiological codes. The best example is GHI in New York. They have these things called "privileging lists" that are a limited # of radiology CPT codes that non-radiological providers can be reimbursed for (And it's harder than you can imagine to get them to provide the info to you). It's because a group of radiologists in their area threatened to terminate their contracts if GHI kept allowing physicians to perform services that they specialize in, rather than referring the business to them. Check with the payer. Their policies will make the final determination anyways,
    Last edited by btadlock1; 12-07-2010 at 04:19 PM.

  6. #6
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    To put it in simple terms.

    You contract a radiologist to read and he doesn't bill the insurance company? You bill globally.

    Your radiologist bills the professional component to the insurance company? You just bill the technical component.

    When billing globally or the technical component you put the referring physician's name in the claim.

    This is where i am not sure, but i would recommend that the radiologist who reads the studies be under your tax ID so they can match your company with him when they request documentation so there is no confusion on who is the physician who is reading this X-Ray study and why isn't he associated to the company. I work in a Diagnostic Testing Facility and thats what I have done when i enroll with insurance companies and it worked fine but i don not know if it would apply to an IM practice.

    If you have any other questions message me.

  7. #7
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    Thank you all for your information and I will look into insurance specifics because it is for a practice in NY.

  8. #8
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    Quote Originally Posted by eafaoro1 View Post
    Thank you all for your information and I will look into insurance specifics because it is for a practice in NY.
    Imagine my surprise when I learned those rules - we're not even contracted with the company and had no idea that they had such a policy - we're in Texas. We found out AFTER our claim denied and about 7 or 8 appeals. It was kind of BS, really.

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