Outpatient Facility Coding Alert - 2014 Issue 45
Reimbursement: Follow 5 Steps to Ensure You're Handling Specialist Payment Arrangements Correctly
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Article Overview
This article explains general considerations for practices that bill a service while paying another physician or specialist for part of the work. It focuses on contract setup, claim reporting, payer expectations, and compliance themes involving Medicare, private payer policies, and state-level requirements. The piece is aimed at coding, billing, and practice management professionals who handle specialist payment arrangements.
Why This Topic Matters
Improper handling of these arrangements can create compliance and reimbursement risks for physician practices. The article helps readers understand the broad administrative and payer-related issues involved in splitting professional and technical services while keeping claims and contracts aligned with applicable rules.
Article Sections
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Crucial Pointers Help You Avoid Stark Rules Snafus
Discusses general compliance and contract considerations for specialist payment arrangements, including payer and regulatory themes. The section also introduces the need to document the relationship between the parties and coordinate billing-related details.
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Pay Attention to These Areas When Filing Your Claim
Covers claim-filing and reporting topics for the arrangement once it is in place. The section addresses how practices should present the service on the claim and coordinate the roles of the participating providers.
What You Will Learn
- What types of specialist payment arrangements the article addresses
- Which compliance and payer issues are raised for these arrangements
- What contract and claim documentation topics are discussed
- How the article frames Medicare and private payer considerations at a high level
- What billing workflow areas are highlighted for practices and coders
Who Should Read This
- Medical coders
- Billing staff
- Practice managers
- Revenue cycle professionals
- Physician office administrators
- Compliance staff
Codes Discussed
Modifiers Discussed
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