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Billing other physicians?

  1. Default Billing other physicians?
    Medical Coding Books
    I have a question. I work for a medical office. When my physician see's and treats an outside physician and/or the family, do i bill the insurance company and have them pay thier balance due or do we write off the balance due? Is thier somewhere i can look up the legal aspects of the issue? When is it fraud?

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    Quote Originally Posted by riverloverjen38@yahoo.com View Post
    I have a question. I work for a medical office. When my physician see's and treats an outside physician and/or the family, do i bill the insurance company and have them pay thier balance due or do we write off the balance due? Is thier somewhere i can look up the legal aspects of the issue? When is it fraud?
    Below is CMS' guidance on family members...Section 130

    A. General
    These are expenses that constitute charges by immediate relatives of the beneficiary or by members of their household. The intent of this exclusion is to bar Medicare payment for items and services that would ordinarily be furnished gratuitously because of the relationship of the beneficiary to the person imposing the charge. This exclusion applies to items and services rendered by providers to immediate relatives of the owner(s) of the provider. It also applies to services rendered by physicians to their immediate relatives and items furnished by suppliers to immediate relatives of the owner(s) of the supplier

    http://www.cms.gov/manuals/Downloads/bp102c16.pdf

  3. Default
    Yes, you do have to bill the physician for their balance due. There is no such thing anymore as professional courtesy, you should only write off charges due to a financial hardship. I would probably google proffesional courtesy, Stark violation, and/or look at your local Medicare website for info in writing.

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