US · guidance
CMS Pub. 100-04, ch. 6, § 80.2
Payment to Employer of Physician
SNF-508, SNF-510
Subject to the conditions and limitations described below, payment of Part B benefits due
a physician under assignment for services furnished in a facility may be made to the
facility if the facility and physician have an agreement under which only the facility may
bill and receive fees or amounts charged for the services.
40.1
Form CMS-855R must be completed to describe the arrangement with the facility. This
form and instructions for completing it can be downloaded from the CMS Forms Web
page. See the Medicare Program Integrity Manual for processing instructions after
completion.
The contractual arrangement between the facility and a physician may apply to all
services the physician furnishes in the facility, or merely to a particular category of
services that is clearly distinguishable from other categories. The distinction between the
categories must be consistent with proper determination of Part B reimbursement and
may not be based on whether the patient has Medicare.
While the law permits physicians to reassign to a facility the Part B benefits for the
patient care services they perform in the facility, this exception in favor of the facility is
intended to apply to an arrangement in which the facility obtains a significant degree of
control or interest in the disposition of the benefits. Under the law, Medicare benefits
cannot be paid to a facility under terms that make the facility a mere conduit for payment
to another person or entity.
EXAMPLE
Under an agreement between a facility and a partnership of teaching physicians, the
facility bills and receives payment in its name for the physician services but is required to
turn over to the partnership all fees received, less a small deduction to defray billing
expenses. The partnership distributes the monies received among its physician members
in accordance with the partnership agreement. Since the SNF functions under the
agreement as a mere conduit for payment to the partnership, the agreement is not an
acceptable contractual arrangement for purposes of the exception to the prohibition on
reassignment.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
3233b3c27241f92b27eefbcaaf5a8d302c049d195b5aecc2d305e975f6af90c6
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