Practice Management

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    Posted 03-04-2020 16:09
    I just spoke with WPS representative and was told we no longer have to bill teleradiology in the state the radiologist is sitting.   We can bill this in the state the images are generated from.  Has anyone else been told this or have any information?
    Thank you,

    Vickie Chamberlain
    Billing Operations Manager
    Evansville Radiology, PC
    Evansville IN
    (812) 422-3254


    Posted 03-04-2020 16:11

    We were also told that information for a physician we had in Tennessee.


    Thank you,


    Carol Hamilton, MBA, FRBMA, FACMPE, SHRM-SCP

    Chief Administrative Officer

    West County Radiological Group, Inc.

    11475 Olde Cabin Road, Suite 200

    St. Louis, MO 63141

    P: 314-991-8201

    F: 314-991-8282

    C: 314-307-2518



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    Posted 03-04-2020 16:21

    Does anyone know where this new information can be found?  It would be GREATLY appreciated!




    Vickie Marshall, RCC   

    Central Kentucky Radiology, PLLC

    859-219-0542 x 7742

    859-918-0476 fax



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    Posted 03-04-2020 17:05

    At least for reassigned claims, Medicare Claims Processing Manual (PUB. 100-04), Chapter 1, § still appears to be the guidance from CMS.


    "Though a supplier or provider may reassign payment for his services to another entity, suppliers are still required to bill the correct B/MAC for reassigned services when they are paid under the MPFS. The billing entity must submit claims to the B/MAC that has jurisdiction over the geographic area where the services were rendered. Suppliers and providers must also meet current enrollment criteria stated in chapter 10 of the Program Integrity Manual in order to be able to bill for reassigned services."




    Thomas W. Greeson

    Reed Smith LLP
    7900 Tysons One Place, Suite 500

    McLean, VA 22102
    703.641-4340 Fax


    Follow us on Twitter @ReedSmithHealth




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    Posted 03-04-2020 18:48
    What if it a claim with respect to an employed radiologist who reads from a different jurisdiction from that in which the TC is performed?

    Larry Buchwalter
    Sent from my iPhone
    Please pardon any typos


    Posted 03-04-2020 19:16
    Larry - I believe your example is precisely the kind of arrangement anticipated by the "reassigned" services rule that Tom referenced . . .

    John Outlaw
    Vice President, Compliance
    Strategic Radiology
    Florence SC


    Posted 03-04-2020 19:07
    I believe the answer actually depends on the nature of the relationship the billing entity has with the physician who performed the service . . .   

    As Tom pointed out, claims for "reassigned" services must be billed to the B/MAC with jurisdiction based upon the geographic are where the services were rendered (ref MCPM Chapter 10, Section    

    However, the rules are different when submitting claims for "diagnostic tests subject to the anti-markup payment limitations" . . .. and I suspect that's where there may be confusion. We're not allowed to say "purchased services" anymore, but that's typically what these are - technically, the correct Medicare language involves physicians who do not "share a practice" with the billing provider. In these cases, the billing entity "must submit all claims for anti-markup tests to their local B/MAC" and the "B/MACs must accept and process claims for services subject to the anti-markup payment limitation when billed by suppliers enrolled in the B/MAC's jurisdiction, regardless of the location where the services were furnished." The billing entity must "report the name, address, and NPI of the performing physician or supplier on all anti-markup  . . .  claims, even if the performing physician or supplier is enrolled in a different contractor's jurisdiction."  Ref. MCPM Chapter 1, Section

    For more on the diagnostic tests subject to the Anti-Markup rule, see also:

    30.2.9 - Payment to Physician or Other Supplier for Diagnostic Tests Subject to the Anti-Markup Payment Limitation 
    30.3.7 - Billing for Diagnostic Tests (Other Than Clinical Diagnostic Laboratory Tests) Subject to the Anti-Markup Payment Limitation 

    John Outlaw
    Vice President, Compliance
    Strategic Radiology
    Florence SC