Processing and Payment of Physician and Non-Physician Practitioner Services Reassigned to Ambulatory Surgical Centers (ASCs)
MLN Matters® Number: MM6358
Related Change Request (CR) #: 6358
Related CR Release Date: May 1, 2009
Effective Date: January 1, 2008
Related CR Transmittal #: R488OTN
Implementation Date: October 5, 2009
Provider Types Affected
Physicians and Non-Physician Practitioners submitting claims to Palmetto GBA for services provided to Medicare beneficiaries.
Provider Action Needed: Impact to You
This article is based on Change Request (CR) 6358 which instructs Medicare Contractors to modify their systems to correctly accept, process, and provide payment for physician and non-physician practitioner services reassigned to Ambulatory Surgical Centers (ASCs).
What You Need to Know
ASCs, that have entered into reassignment agreements with physician or non-physician practitioners, and whose reassignment has been approved by the Centers for Medicare & Medicaid Services (CMS) through the form CMS-855R, may bill for and receive payment for reassigned physician and non-physician practitioner professional services. CR 6358 instructs Medicare Contractors to modify their systems to correctly accept and process reassignment claims from ASCs, and reprocess valid reassignment claims brought to their attention for dates of service on or after January 1, 2008 that were not previously paid to either the ASC or the physician/non-physician practitioner.
What You Need to Do
See the Background and Additional Information Sections of this article for further details regarding these changes.
Background
The Social Security Act Section 1842(b)(6) (www.ssa.gov/OP_Home/ssact/title18/1842.htm) states in part, that no payment for a service may be made to anyone other than the physician or other person who provided the service, unless one of the exceptions to the prohibition on reassignment is met.
When applicable, physicians and non-physician practitioners may reassign their right to bill and receive payment to an ASC if they meet the reassignment exceptions in Title 42 of the Code of Federal Regulations (CFR) Section 424.80
ASC payment system updates were provided by:
However, the system updates made to the ASC payment system by CR 5572 and CR 5680 did not include necessary system provisions to correctly process claims for physician and non-physician practitioners who reassign benefits to ASCs under the ASC payment system for Dates of Services on or after January 1, 2008. CR 6358 remedies that problem and Medicare Contractors will accept and process reassignment claims from ASCs. Also, Medicare contractors will reprocess valid reassignment claims brought to their attention for dates of service on or after January 1, 2008 that were not previously paid to either the ASC or the physician/non-physician practitioner.
Note: Medicare requires a valid reassignment application(s) to be on file with Medicare contractors in order to pay ASCs for physician or non-physician practitioner services.
Additional Information
If you have any questions, please contact our Provider Contact Center at our toll-free number (866) 332-7025 (Ohio and West Virginia) or (888) 828-2092 (South Carolina Part B).
Disclaimer
This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2008 American Medical Association.