David:
Many thanks for your explanation.
My costs of operating in the Washington, DC metro and Baltimore, MD metro areas are the same.
Yes...sadly reimbursements in general are a maze of - IMHO - draconian rules that put providers at a
truly unfair advantage and especially with commercial insurance make us unable to negotiate fair reimbursement.
Any hope of respectfully correcting this?
For me - and all the good people in our industry - it's all about the best possible patient care. We're just asking for the opportunity to FAIRLY COMPETE in the marketplace and compensate our employees fairly and receive a reasonable return on investment.
Our company has been in business for 26+ years and in the current market I would not recommend
anyone consider the huge cash investment to open a new imaging center.
But I believe I'm "Preaching to the Choir".
Regards
Bill
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William Kisse
COO
Washington Open MRI, Inc.
Rockville, MD
bill@womri.com(301) 424-4888
https://www.linkedin.com/in/billkisse/------------------------------
Original Message:
Sent: 10-28-2019 10:35
From: David Smith
Subject: Billing for radiologist reading remotely
Hi William
The reasoning for split billing is that the Medicare Physician Fee Schedule payment rates are based on the cost of operating in a given locality (this is the role of the Geographic Practice Cost Index or GPCI). If you accept that this is a reasonable approach, then it stands to reason that Medicare should pay based on where the service is rendered...it wouldn't make sense to pay a physician sitting here in Kansas City the same amount as a one sitting in San Francisco where costs are much higher.
Having said that, I think the whole cost based approach is flawed, since supply and demand are removed from the equation. That's what leads to Medicare being the worst payor in some markets and the best in others, and contributes to an uneven distribution of physicians.
BTW, as long as that physician is sitting in the same Medicare payment locality where the TC is rendered, and you meet the other requirements for global billing, you should be able to bill globally even if the doctor isn't sitting in your imaging center.
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David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
Original Message:
Sent: 10-28-2019 10:10
From: William Kisse
Subject: Billing for radiologist reading remotely
That is correct.
You only have to split-bill for Medicare patients.
It's another rule to follow that does nothing to help our patients receive the best care.
Does anyone know the reason for this?
If a radiologist is qualified and licensed to read a scan and as all images are now digital, why does it matter where the radiologist is located if he performs his services?
I have a radiologist on staff in the Maryland/Washington DC area and if he is not physically present at our office in Baltimore it's split billing?
IMHO nonsense.
Can anyone help here?
Thank you
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William Kisse
COO
Washington Open MRI, Inc.
Rockville, MD
bill@womri.com
(301) 424-4888
https://www.linkedin.com/in/billkisse/
Original Message:
Sent: 10-08-2019 15:44
From: Shannon Helton
Subject: Billing for radiologist reading remotely
We only split bill to Medicare. This is not required by any other payers to my knowledge, although payer requirements can vary as we all know and I don't bill to any Florida payers aside from FL Medicare.
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Shannon Helton, CPC
Client Manager
Change Healthcare
shannon.helton@mckesson.com
Original Message:
Sent: 10-08-2019 15:17
From: Carrie Teegarden
Subject: Billing for radiologist reading remotely
Hi Shannon,
Your response was very helpful and confirmed what I thought was required. I am wondering about other insurance plans such as commercial insurances, BCBS, Medicaid, Tricare and Medicare replacement plans. Can they be globally billed or do you have to split bill them to for the remote radiologists? I want to be prepared if other insurances require it but I will also confirm when I credential the radiologist. I appreciate any heads up I can get!
Thanks so much!
Carrie Teegarden
Billing Manager
Advanced Imaging Concepts, PL
Brooksville FL
Original Message------
Hi Carrie,
I have the same situation with an imaging center located in Michigan - they have radiologists reading remotely from Illinois, Rhode Island, and Florida. We global bill to MI Medicare for studies read by physicians who are sitting in Michigan. But we have to split bill technical components to MI Medicare and professional components to either IL, RI, or FL Medicare for studies read by the out of state physicians. We had to enroll all of the remote radiologists in both Michigan Medicare and their local Medicare Part B plan. The location billed on the professional component claim will be the address where the physician is sitting when he/she reads the study.
I don't want to get into the specific CMS forms that you would need to complete because I might give you the wrong answer, but I hope this helps.
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Shannon Helton, CPC
Client Manager
Change Healthcare
shannon.helton@mckesson.com
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