Hi Ginger
I don't think the form or content of the preliminary read will matter, since you won't be billing for it.
With respect to Medicare, unless the reading radiologist meets the Medicare criteria for "sharing a practice", which sounds unlikely, you will not be able to bill globally, per se. You can bill the professional and technical components separately, but you will have to bill the professional component under the anti-markup rules (see
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM6733.pdf). Note that you will have to report the address where the reading radiologist sits as the service location in Box 32, and if it's different from your address enroll those addresses with Medicare. If the address is in a different MAC jurisdiction, you will have to enroll and file the claims there.
With respect to Commercial insurance or Medicaid, check your contracts and payor policies. Most won't have a problem with global billing, but there may be some that prohibit billing for services purchased from another physician group.
------------------------------
David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
------------------------------
Original Message:
Sent: 03-15-2021 09:39
From: Ginger Hooper
Subject: Billing and documentation of preliminary read of CT scans
Hello, We are a Radiation Oncologist practice and have our own CT machine in an office setting. We have a new doctor to our practice who is not a certified radiologist and does not read. He will be doing a preliminary read of the scans and we will send the images to an outside radiologist group for a final report. With our new doctor doing the preliminary read, can we still bill global, and what kind of documentation should be stated by our new doctor?
Thank you,
Ginger Hooper
------------------------------
Ginger Hooper
Billing Supervisor
Dattoli Cancer Center
Sarasota FL
(941) 955-8088
------------------------------