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 for the responsibility taken and the work completed. Called a “split surgical claim” or “split claim,” each surgeon is required to submit their claim 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. Factors that cause these problems include:
- Manitoba Health always pulls the claim 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 specific tariffs claimed or the percentage of the total payment to be apportioned to each surgeon, which can cause the rejection of the claims.
Doctors Manitoba recommends that, where possible, AVOID SPLIT CLAIMS. Submit claims with a principal surgeon and surgical assistant (when applicable) and reconciliation should be handled directly between the surgeons and/or their billing staff.
Avoiding split claims 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, ensure agreement concerning all tariffs and the percentage of the payment to be apportioned to each surgeon.
It is beneficial to instruct billing staff to verify with the other surgeon’s billing staff that the information being submitted on the claims is consistent. As well, this will serve as a reminder to the other surgeon to submit their claim in a timely fashion