CMS Pub. 100-04, ch. 1, § 30.2.12

Payment on Basis of Reassignment - for Carrier Processed Claims

(Rev. 1, 10-01-03)

B3-3060.8

Any person or entity wishing to receive Part B payment as a reassignee of one or more

physicians (or other practitioner or supplier), or as the supplier of the services, must

furnish to the carrier sufficient information to establish clearly that it qualifies to receive

payment for those services. Where there is any doubt that the person or entity qualifies,

the carrier must obtain additional evidence.

In some cases, an entity may qualify to receive payment for the services of a physician on

the basis of one or more of the exceptions listed in §30.2. As soon as it is determined that

an organization can qualify on any basis, no further development may be needed for that

physician or for other physicians having the same status. However, where some other

physicians have or appear to have different status, further development is required. In

some cases a determination is made that Part B payment can be made only to the

physician.

Subject to the provisions of §§30, a reassignee assumes liability for any overpayments

that it receives and should be so advised.

A. Payment to Special Accounts

Sometimes a major institution, such as a medical school or university, may want the

Medicare checks due it for physician services to go into particular specialty accounts (or

funds, or so-called group practices) which are subdivisions of the institution, and may ask

that these accounts be identified on their Medicare checks for internal accounting

purposes.

Ideally, to indicate the subordinate nature of the account in relation to the institution,

carriers list the name of the institution first on the check, followed by the name of the

appropriate account. However, identifying the payee in this manner may cause serious

claims processing difficulties, fostering confusion between various accounts of the same

institution. To avoid this problem, carriers may list the name of the account first,

followed by the name of the institution, e.g., Radiology Fund or General Medical Center,

if the institution submits a letter accepting responsibility for any claims submitted, and

payments made, under the special designations. The letter needs to describe the special

designations the institution wants on the checks for the various accounts and include a

statement to the following effect:

The (name of institution) accepts the same responsibility for the Medicare claims

and payments made under these special designations as it would have if the

payments were made by Medicare in the name of (name of institution) without

these special designations.

This statement is required in addition to the statement the institution submits to establish

its right to receive payment for the physicians’ services.

If the above procedure is used as a basis for Part B payments in the names of

departments, specialties, or similar subdivisions of a university or medical school or an

associated nonprofit foundation or teaching hospital, each subdivision may also execute,

or refrain from executing, a participation agreement for physician services in that

subdivision. This is an exception to the rule that a participation agreement may only be

executed by a person or legal entity. This exception applies only in the medical school or

university medical center context.