BILLING FOR OUTSIDE XRYS

H.E.L.P.
I posted this question last week and got a response but I need the source documents to support my case.

We are renting a suite at our facility to a FAMILY PRACTICE doc who would like us to to perform his XRYS for him and he will read them.
Everything I am finding indicates that this should be billed as follows: xry,26(FAMILY PRACTICE bills this)
xry,TC(our facility bills this)

Is it possible to bill the FP doc a set dollar amount every month for a set amount of xrys taken and let him bill both the 26 and TC portions of the xry?
Can anyone point me in the direction of the documentation stating if this is ok or not?
Margie? Ruby?

Comments

  • edited May 2017
    This is called a purchased service and there are very specific rules that
    you must follow if the family practice is purchasing your interpretation
    for their imaging.

    "
    Orthopedic Pink Sheet Newsletter (official sources below)

    If your orthopedic practice purchases either the professional component
    (PC) or technical component (TC) of its diagnostic tests, and you also bill
    Medicare for these components, make sure you comply with Medicare's
    toughened anti-markup rules.
    The rules took effect July 1 2010, with an implementation date of July 6,
    according to CMS Transmittal 445, dated Feb. 13. Technically, however, the
    provisions were laid out in the 2009 final physician fee schedule and
    should have taken effect Jan. 1 this year.
    What you must do:
    * 1. Determine whether the anti-markup rules apply to services you
    provide to your patients. You may need to do separate checks for both your
    PCs and TCs (see the Two Tests box below); and
    * 2. Make changes to either comply with the rules, or set up your
    business arrangements so the anti-markup rules do not apply to you.
    In effect, the new rules prevent you from billing Medicare for more than
    you pay for either the PC or the TC of a diagnostic test - if you pay
    someone outside your practice to perform it and then you bill Medicare for that
    service as though you did it yourself.
    Some orthopedic practices now contract with a radiologist to do the
    official interpretation for the imaging tests they perform. For example, an
    orthopedic practice might have its own MRI unit and bill the technical, while a
    radiologist will do the interpretation of the scans.
    The anti-markup rules would apply if the orthopedic practice then pays the
    radiologist for his interpretations, then bills Medicare for that
    professional service, in addition to the technical component.
    Note: If you do both the PC and TC in your office, nothing should change.
    For these services, continue to bill the global (no modifier) code.
    You must perform either PC or TC: Medicare rules specify that in order to
    bill for either a PURCHASED professional or technical component of a test,
    you must actually perform one of the components (Claims Processing Manual,
    100-04, Chapter 35, Section 30).
    For example, say the test is performed in the hospital setting. An
    orthopedic practice would not be able to purchase the professional component and
    then bill it to Medicare, because you are not providing the technical
    component.
    In other words, you may only purchase and bill for the professional
    component when you are doing the TC of the test in your office.
    Revisit standing arrangements: If your orthopedists have a standing
    arrangement for a radiologist to do PC interpretations of your tests, you will
    need to ensure those arrangements comply with the stricter anti-markup rules,
    says Mike Carlson, an attorney with Maynard, Cooper Gayle, Birmingham,
    Ala.
    Until now, the physician providing the PC may have agreed to a contracted
    fee that is less than the Medicare PC rate (often 80% of Medicare, Carlson
    says). In many cases, that will need to change under the anti-markup rules
    - and you may find yourself paying these interpreting physicians a higher
    fee, the attorney says.
    To continue this arrangement unchanged, your orthopedic practice will have
    to put the PC service arrangement to the two anti-markup tests
    (substantially all and site of service - see box, page 6). If the arrangement passes
    either test, it escapes the anti-markup limitation, and you can continue to
    pay the radiologist a discounted rate for the PC, then bill Medicare for
    both the TC and PC.
    The typical arrangement with an interpreting radiologist would not be able
    to meet the substantially all test, which would require the radiologist to
    do at least 75% of his services for the billing provider, Carlson says.
    That leaves the site of service test, which requires the service be
    performed in the office of the billing physician. To satisfy that requirement,
    the orthopedic practice would need to request the radiologist come to its
    office to do the reads, Carlson says.
    If you can't figure out a way to avoid coming under the anti-markup rules,
    you may decide the radiologist performing the PC should simply bill
    Medicare directly for the service.
    Official resources:
    To view the final 2009 Medicare physician fee schedule, see the Nov. 19,
    2008 Federal Register, at:
    _www.access.gpo.gov/su_docs/fedreg/a081119c.html_
    (http://www.access.gpo.gov/su_docs/fedreg/a081119c.html)
    To download CMS Transmittal 445, visit:
    _www.cms.hhs.gov/transmittals/downloads/R445OTN.pdf_
    (http://www.cms.hhs.gov/transmittals/downloads/R445OTN.pdf)
    For more Medicare policy manual requirements for billing PURCHASED tests,
    see: _www.cms.hhs.gov/manuals/downloads/clm104c01.pdf_
    (http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf)



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