Coding Cues: Billing for family members

March 21, 2008

One of my associates is treating the father of the senior partner in our corporation and billing Medicare for his services. It's my understanding that CMS doesn't permit a physician to bill for medical services provided to his own family members or those of other doctors in his group, but others in our practice disagree. Who's right?

One of my associates is treating the father of the senior partner in our corporation and billing Medicare for his services. It's my understanding that CMS doesn't permit a physician to bill for medical services provided to his own family members or those of other doctors in his group, but others in our practice disagree. Who's right?

You are. According to the Medicare Benefit Policy Manual (updated in February 2007), it is inappropriate to bill Medicare for services rendered to immediate relatives of a provider or an owner of a provider. In this context, "owner" refers to the professional corporation employing the provider. "Immediate relative" is broadly defined as a husband or wife; natural or adoptive parent, child, or sibling; stepparent, stepchild, stepbrother, or stepsister; and grandparents, grandchildren, and their spouses. In-laws are also considered immediate relatives, even after divorce or death of the primary family member. In many cases, cohabitants are, too.

The father of a partner in your group clearly falls within the billing prohibition.

The author, vice president of operations for Reed Medical Systems in Monroe, MI, has more than 30 years' experience as a practice management consultant, as well as being a certified coding specialist, certified compliance officer, and a certified medical assistant.

Related Content:

Practice Management