MEDICARE Q&A: Fall Update Print
Written by Benjamin L. Frosch   
Wednesday, 22 September 2010 21:40

Q:   I am an Administrator at a Cardiology practice that is purchasing an ultrasound machine and radiology equipment to perform procedures in our office.  We will satisfy the necessary supervision requirements with a non-radiologist, however, we will have a radiologist perform the professional interpretation off-site.  If we hire the radiologist on a part-time basis, will our group practice be allowed to bill Medicare globally for the procedures?  If not, under what circumstances can we bill globally?


Cardiology Practice

A:   There are many issues that have to be considered in your scenario.  If the radiologist is performing the professional interpretation off-site and is a purchased service, the CMS purchase interpretation rules would come into play.  The rules states: an entity that provides diagnostic tests may submit the claim and receive the Part B payment for diagnostic test interpretations which that entity purchases from the independent physician if;

  • The tests are initiated by a physician or medical group which is independent of the person or entity providing the test and of the physician or medical group providing the interpretations;
  • The physician or medical group providing the interpretation does not see the patient; and
  • The purchaser performs the technical component of the test.  The interpreting physician must be enrolled in the Medicare program and no formal reassignment is necessary.
  • The purchaser must keep on file the name, the provider identification number, and the address of the interpreting physician.

The first bullet above states that the test has to be" initiated" by a physician or medical group which is independent of the person or entity providing the test. In simple words, that means if you "ordered" the ultrasound and purchased the interpretation, you would not be able to bill Medicare globally.

With respect to the physician working on a part-time basis in lieu of purchasing the services, you may have an issue with the Stark regulations or even some state laws. The radiologist may be required to provide these interpretations on the site of your practice. You may want to check with a seasoned healthcare attorney to assure that you comply with all of these complex rules, regulations, and guidelines.

Q:  I just received a letter from Medicare informing me of a substantial overpayment. My staff researched this issue and we concluded they are correct with the overpayment determination.  The letter we received states that it is a follow-up letter. I never received the initial notification of an overpayment from Medicare.  My question addresses the interest on this overpayment.  What are the rules on Medicare assessing interest on an overpayment?


Ft. Lauderdale, Fl

A:  Medicare does not charge interest on overpayments that are received within thirty-days.  After the thirty day period, interest is assessed for the first thirty-day period and an additional thirty-day period.  Interest continues to accrue for each subsequent thirty-day period for which payment is not received by Medicare.   When money is offset (withheld from Medicare payments), it is applied to the accrued interest first and then to the principal.   The follow-up overpayment letter probably does not imply you have another thirty-day period to refund the amount nor does it prevent Medicare from withholding future payments after the thirty-day period has elapsed.  If you do not refund the overpayment within forty-days from the date of the initial refund request letter, Medicare may initiate offsets and pursue other efforts of recovery of the indentified overpayment.

The bottom line is, once you receive notification of the overpayment; return the monies as quickly as possible.  The overpayment is considered a debt owed to the United States Government and you can always appeal if you feel that Medicare is incorrect with the allegations of the overpayment or the interest payment.  

Q:  I own and operate a multi-modality Independent Diagnostic Testing Facility (IDTF).   I want to take advantage of the weak real estate market and relocate my facility to a nearby site with better street frontage and other amenities.  My administrator warned me that the move will require recertifying our provider number and may hold up Medicare reimbursements for up to six months.   Is my administrator correct about recertification and could it really delay payments for six months?    


Orlando, FL

A:  In accordance with the Medicare IDTF Standards,  changes in ownership, changes of location, changes in general supervision, and adverse legal action must be reported to Medicare Provider Enrollment within thirty-days of the change.  Should you change your location, it should not delay or hold up your Medicare reimbursement. There is a possibility that you would be required to revalidate, but that is based on other rules. All Medicare providers must revalidate every 5 years. Should you move and be required to revalidate, it would not impact your reimbursement during the process.  Should you submit the proper CMS 855 documents for only change of location, this action would also have no impact on your Medicare reimbursement.

About the author:  Mr. Frosch is the President of Frosch Medical Consultants in Plantation FL

Last Updated on Sunday, 14 August 2011 16:55