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Adding to the fine print that goes with deciding when it is OK to waive copayments or provide physician courtesy services for free, Medicare has restated a relatively obscure ban on reimbursing doctors for any services they provide to immediate relatives of their partners and colleagues.
The rationale: Practices should not bill for such services because they would probably have been provided for free if Medicare was not there to pay for them.
Medicare’s ban on billing for immediate family members was first introduced in the 1994 carrier manual. Now a 2001 Illinois-Michigan carrier bulletin declares: "Medicare will not cover charges by providers who are immediate relatives of the beneficiary or by providers who are members of a beneficiary’s household. Medicare excludes payment for these providers because items and services furnished by them would ordinarily be furnished free of charge based on their relationship to the beneficiary. This exclusion applies to physician services, including services of a physician who belongs to a professional corporation and services incident to those services."
Not only does the ban include physician services provided in-office but also any physician extender services provided incident to the physicians’ services in the office, ancillary tests provided in the office, and hospital consults physicians provide to relatives of colleagues, say experts.