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Radiology Billing - ordering physician

  1. #1
    Default Radiology Billing - ordering physician
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    Our group has been in negotiations with a radiologist for coverage and over reads. He currently works for other places as well and I have found that the other clinics do not bill using the radiologist as the rendering for any of the radiology services. They bill these services (globally) under the ordering physician. I did not think that was the correct method for billing, however my medical director now wants to pursue this method of billing if possible. Can anyone tell me if this is an allowable way of billing for radiology services?

    Valarie, CPC

  2. Default
    Hay Valrie, we are having this same issue. I have written to Medicare under the freedom of information act and nothing in their regulations spell out how to bill for this situation. I agree with you, since the rendering provider is not part of your group you cannot bill using his NPI. The ordering provider did not provide the service but is being charged by the rendering physician for the reading. It is a catch 22 situation.

    I will be very interested in hearing how others handle this. So far, we are not billing globally for services.


  3. #3

    Please keep me updated with the progress of this if you dont mind. I will be very interested in the out come. I dont want to start billing under the referring as I just dont feel it is the proper way to bill. Thanks so much!


  4. #4
    Alexandria, LA
    This falls under the "anti-mark-up" rules. Look at Chapter 1 of the CMS Claims Processing Manual section 30.3.7.

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