anti-markup rules

We have a orthopaedic practice and have our own MRI unit. A outside radiology group reads our MRI's and they bill us per study. we bill the global fee. should we be coding our MRI scan with the TC and 26 modifiers? or are we ok billing the global? can someone explain to me how we should be billing the MRI studies out for medicare patients
thanks

Get a lawyer- STAT!

I am 99.9% certain that for Medicare you cannot bill for the radiologists if they are not part of your corporation. They must bill for their own services and you bill for the TC only.

Let Radiologist bill Medicare!!

We have exactly the same situation, and per CMS guidelines, unless the radiologist is willing to sign up to be part of your group, they will have to bill Medicare directly for their services. We make the demographic info available for the radiologist to take to his office on the morning he reads the xray on all regular Medicare patients and they subtract those patients from the fees they bill us, so they aren't paid twice. This is only for regular Medicare not the Medicare managed care plans.

Info re anti-markup question

The situation you are describing is a purchased professional component. I found this information through some links on the CMS & Palmetto website.

After reading through the information, it seems to me that the concerns regarding anti-markup of purchased services has more to do with Lab tests and the purchasing of the technical component of radiology services.

I think the main thing that CMS is concerned about is making sure the beneficiaries are receiving pertinent care and all providers involved are in the USA. According to CMS, some providers/groups that purchase diagnostic equipment for their office seem to order more tests than providers/groups that don't have them.

You should keep on file the name and ID (NPI) of the interpreting MD for future reference in case CMS wants to review the information in the future. If they were to review these claims, you would also want to have the contract between your group and the interpreting physician(s) available.

Some of the things your group should ask itself is:
Are we compliant with regard to the self-referral prohibition rules?
Are the MD's performing the purchased services enrolled with and eligible to participate in Medicare?
Are the MD's physically located in the same Medicare carrier jurisdiction?

Hope some of this is helpful.

From the Palmetto Website: "Purchased Professional Component
A person or entity that provides diagnostic tests may submit the claim and if assignment is accepted, may receive the Part B payment for diagnostic test interpretations which that person or entity purchases from an independent physician or medical group if:

The tests are initiated by a physician or medical group which is independent of the person or entity providing the tests and of the physician or medical group providing the interpretations
The physician or medical group providing the interpretations does not see the patient
The purchaser, employee, partner or owner of the purchaser performs the technical component of the test. The interpreting physician must be enrolled in the Medicare program. No formal reassignment is necessary.
The purchaser must keep on file the name, provider identification number and address of the interpreting physician. The rules permitting claims by a facility or clinic for services of an independent contractor physician on the physical premises of the facility or clinic are set forth in the CMS Medicare Claims Processing Manual (Pub. 100-04, Chapter 1) (PDF, 1.51 MB)."