Split Surgical Claims

The Physician’s Manual (Rule of Application 30) allows two surgeons, by prior agreement, to jointly claim for surgical services and apportion the total fee in relation to the responsibility taken and the work done. This is commonly referred to as a “split surgical claim” or “split claim”. Each surgeon is required to send in his/her own claim card showing the agreed apportionment to each surgeon (e.g. 60% for surgeon A, 40% for surgeon B etc.).

Unfortunately, split claims typically lead to significant processing problems and ultimately result in delayed payment. There are several factors that cause these problems, including:

  • Manitoba Health always pulls the claims from the payment system for manual review by a medical assessor.
  • Processing does not begin until claims are received from BOTH surgeons.
  • There are often inconsistencies with the specific tariffs claimed or the percentage of the total payment to be apportioned to each surgeon, which can cause the claims to be rejected.

Doctors Manitoba recommends that, where possible, SPLIT CLAIMS SHOULD BE AVOIDED. Claims should be submitted as a principal surgeon and surgical assistant (when applicable) and reconciliation should be handled directly between the surgeons and/or their billing staff. This should be relatively straightforward if you routinely participate in split surgical cases with another surgeon or share a common billing office.

If you must submit a split surgical claim, it is important to ensure that there is agreement with respect to ALL TARIFFS TO BE CLAIMED AND THE PERCENTAGE OF THE PAYMENT TO BE APPORTIONED TO EACH SURGEON. In this regard it would be beneficial if you instructed billing staff to verify with the other surgeon’s billing staff that the information you are each submitting on your claims is consistent. As well, this will serve as a reminder to the other surgeon to submit his/her claim in a timely fashion.

Questions?

Ian Foster
ifoster@docsmb.org
(204) 985-5854

 

Updated: December 2016