Billing Professional Courtesy
Billing Professional Courtesy: Physicians may provide ?Professional Courtesy? discounts to other physicians, as well as to those with whom they work or have a personal relationship (e.g., office staff, hospital employees, and family members).
Medicare stipulates that a physician cannot bill for services or ordered services for his/her immediate family member, as shown below. Per the Medicare Carriers Manual [14-3-2332]:
Do not pay under Part A or Part B of Medicare for expenses, which constitute charges by immediate relatives of the beneficiary or by members of his/her household. The intent of this exclusion is to bar Medicare payment for items and services furnished by physicians or suppliers, which would ordinarily be furnished gratuitously because of the relationship of the beneficiary to the person imposing the charge. This exclusion applies to items and services rendered by a related physician or supplier, even if the bill or claim is submitted by an unrelated individual or by a partnership or a professional corporation. It applies to items and services furnished incident to a physician?s professional services (Eg: by the physician?s nurse or technician) only if the physician who ordered or supervised the services has an excluded relationship to the beneficiary. The only exception is items furnished by an incorporated non-physician supplier.
The following degrees of relationship are included within the definition of immediate relative:
- Husband and wife;
- Natural or adoptive parent, child, and sibling;
- Stepparent, stepchild, stepbrother, and stepsister;
- Father-in-law, mother-in-law, son-in-law, daughter-in-law, brother-in-law, and sister-in-law;
- Grandparent and grandchild; and
- Spouse of grandparent and grandchild.
A father-in-law or mother-in-law relationship does not exist between a physician and his/her spouse?s stepfather or stepmother.
A step-relationship and an in-law relationship continue to exist even if the marriage upon which the relationship is based terminates through divorce or through the death of one of the parties. If a physician treats his step-father after the death of his natural mother or after the step-father and natural mother are divorced, or if he treats his father-in-law or mother-in-law after the death of his wife, the services are considered to have been furnished to an immediate relative and are excluded from coverage.
These are persons sharing a common abode with the patient as a part of a single family unit, including those related by blood, marriage, or adoption, domestic employees and others who live together as part of a single family unit. A mere roomer or boarder is not included.
It should be noted that a brother-in-law or sister-in-law relationship does not exist between a physician (or supplier) and the spouse of his wife?s (her husband?s) brother or sister.