MLN Matters® Number: MM6470
Related Change Request (CR) #: 6470
Related CR Release Date: June 12, 2009
Effective Date: January 1, 2008
Related CR Transmittal #: R291PI
Implementation Date: October 5, 2009
Provider Types Affected
Physicians and non-physician practitioners submitting claims to Medicare contractors (carriers and A/B Medicare Administrative Contractors (A/B MACs)) for services provided to Medicare beneficiaries where payment is reassigned to an ASC or to another physician’s practice.
Provider Action Needed
This article is based on Change Request (CR) 6470 and provides clarifying information regarding 1) reassignment of benefits to an Ambulatory Surgical Center (ASC), and 2) situations in which a solo physician/practitioner to whom another physician/practitioner has reassigned his/her benefits dies or has his/her Medicare billing privileges revoked.
Background
Physicians and non-physician practitioners may reassign their benefits to an ASC if they meet the reassignment exceptions in the Code of Federal Regulations (CFR; Title 42, Section 424.80), and the 'Medicare Claims Processing Manual' (Chapter 1, Sections 30.2.6 and 30.2.7). You can review 42 CFR 424.80 at http://edocket.access.gpo.gov/cfr_2008/octqtr/pdf/42cfr424.80.pdf (PDF, 51 KB) on the Internet, and Chapter 1, Sections 30.2.6 and 30.2.7 of the 'Medicare Claims Processing Manual' at www.cms.hhs.gov/manuals/downloads/clm104c01.pdf (PDF, 1.51 MB).
Ambulatory Surgical Centers (ASCs) and Reassignment
If a physician or non-physician practitioner wish to reassign their benefits to an existing (and currently enrolled ASC), both the individual and the ASC must sign form CMS-855R (Visit www.cms.hhs.gov/CMSforms/CMSforms/ItemDetail.asp?ItemID=CMS019478 on the CMS Web site).
However, it is not necessary for the ASC to separately enroll as a group practice in order to receive benefits. It can accept reassignment as an ASC.
Reassignment and Revoked/Deceased Physicians and Practitioners
There are situations where a physician/non-physician practitioner (the 'owning physician/practitioner'):
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Owns 100% of his/her own practice;
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Employs another physician/non-physician practitioner (the 'employed physician/practitioner') to work with him/her; and
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Accepts reassigned benefits from the employed physician/practitioner.
If the owning physician/practitioner dies or has his/her billing privileges revoked:
In these situations, neither the owning physician/practitioner nor the practice is eligible to participate in Medicare, and the billing privileges for both are revoked in accordance with the revocation procedures outlined in the 'Medicare Program Integrity Manual' (Chapter 10 (Medicare Provider/Supplier Enrollment)). This policy applies to practices established as a sole proprietorship, a Professional Corporation (PC), a Professional Association (PA), or a solely-owned Limited Liability Company (LLC). In addition, the Medicare contractor will terminate the reassignments effective on the date of death or the effective date of the revocation.
Additional Information
The official instruction, CR 6470, issued to your carrier or A/B MAC regarding this change, may be viewed at www.cms.hhs.gov/Transmittals/downloads/R291PI.pdf (PDF, 143 KB).
If you have 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.