CODING TIP: TREATMENT TO FAMILY MEMBERS

AUGUST 9, 2016

From time to time we are asked if providers are permitted to bill and treat for family members. While this is a function of the contractual relationship between the Provider and the insurance carrier, the short answer is NO.

Medicare does have a policy that clearly states that the treatment of certain family members is not to be reimbursed by Medicare or any Medicare Advantage program.

The following relationships are including in the definition of family members not covered:

· Husband or wife

· Natural or adoptive child, sibling or parent

· Step-parent, step-child, step-sibling

· Father-in-law, mother-in-law, brother-in-law, sister-in-law, daughter-in-law, son-in-law

· Grandparent or grandchild

· Spouse of grandparent or grandchild.

While this is a Medicare policy, many other Insurance Companies have adopted this as part of their contractual policies with Providers, including Highmark. Additionally, some professional organizations have deemed the practice of treating and billing for family members as unethical. Before treating a family member, the provider should check their individual contract or contact their Provider-relations representatives for clarification.