Payment to Employer of Physician - Carrier Claims Only (Rev. 1, 10-01-03)

by  Find-A-Code
July 17th, 2015

The carrier may pay Part B benefits for covered physician services under an assignment or for enrollees that did not execute assignment before death to the physician’s employer, provided that under the terms of the physician’s employment, only the employer and not the physician has the right to charge or collect charges for the physician’s services, and certain other conditions and limitations described below are met. There must be an employer-employee relationship between the physician and the person or organization hiring the physician to perform services, and the terms of the employment must provide that the employer and not the physician has the right to receive the payment for all the latter’s services within the scope of the employment. If the employer has the right, as a condition of employment, to fees for all professional services the physician renders, including those outside the scope of the employment, honor an assignment of benefits to the employer for all such services.

An employer may establish that it qualifies to receive payment for the services of its physicians by submitting the Form CMS-855R.

The employer must provide evidence that the employee is a valid employee by providing the carrier with a Form W-2 or other acceptable Internal Revenue Service documentation (a pay stub would suffice for new employees who do not yet have a Form W-2.).

Pub 100-04 Medicare Claims Processing Manual

References:

Payment to Employer of Physician - Carrier Claims Only (Rev. 1, 10-01-03). (2015, July 17). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/payment-to-employer-of-physician-carrier-claims-only-rev-1-10-01-03-27258.html

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