Can I Treat Family and Bill Medicare

September 24, 2018
Rick Gawenda

Providers always want to know if they can treat family members who have Medicare as their insurance and submit the claims for those services to the Medicare program and receive reimbursement. Well, to answer that question, we must look at what the Centers for Medicare and Medicaid Services (CMS) has to say on this matter.

The answer can be found in

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  1. So an LLC may treat family members and bill MC? I am not a C-Corp.
    And are family members then still liable for the coinsurance?

    1. I would consult your healthcare attorney regarding the waiving of copays and coinsurance to family members.

  2. Is there any regulatory language addressing whether or not a physician can refer themselves to physical therapy AND sign their own plan of care?

  3. We received an order for therapy and the patient is the referring doctor’s mother. The physician is in a PC, so I know this does not exclude him from the rule – but can we accept this referral or would any services stemming from this referral also be nonpayable?

    1. This is not a question I can answer as you would need to make that determination and/or consult your healthcare attorney.

  4. What about being a practice owner, PLLC, and my therapist wants to treat her husbands back pain, he has good insurance, and it’s not a federal payer like medicare. My guess would be look at the particular insurance plan’s fine print or consult a healthcare attorney.