reciprocal billing for inpatient services

Thank you Nancy. I know this is how it works in the OUTPATIENT setting, but, before I get back to my providers, please let me clarify (this is the disagreement our docs are having), that this is also how it works in the INPATIENT setting.

I appreciate your help and count on your expertise!

Carole

re: reciprocal billing for inpatient services

Reciprocal Billing Arrangements: A recipient regular physician may submit a claim for a covered service which the regular physician arranges to be provided by a substitute physician on an occasional reciprocal basis.

These requirements do not apply to the substitution arrangements among physicians in the same medical group where claims are submitted in the name of the group. On claims submitted by the group, the group physician who actually performed the services must be identified as the rendering physician.

Reciprocal billing refers to an agreement made with, for example, other internists with different tax identification numbers. No money changes hands, and the regular internist compensates the covering internist by reciprocating in the future under similar circumstances. Reciprocal billing applies to times when physicians from different practices are covering for one another. This is often the arrangement used by solo practitioners or two-physician practices.
Medicare Manual transmittal #1780 applies to both outpatient AND inpatient settings.

re: reciprocal billing for inpatient services

Thank you very, very much!

carole