Wiki Physician Credentialing not complete - billing charges question

[Ilove2code]

I just learned the incident to guidelines. I have stopped billing charges for a new physician since he is not credentialed with all the Payers yet. He is credentialed with Medicare. I was told if there is a secondary insurance to Medicare to bill the claim under the ancillary physician on site that day (since the claims will deny on the secondary), and list the credentialed physician as the service provider on the claim. I would like to confirm that I should bill under Medicare and if there is a secondary he is not credentialed with, that the balance would have to be written off? Or should he not see the patient at all? Should I hold all the claims until he is credentialed with everyone? What should I do with the claims that do not backdate to the date of service? What about the claims already billed?

He has also been seeing new patients for insurances he is not yet credentialed with. Should I hold claims until credentialed?

I have been asking people of authority when I do not see another physician on the schedule for the same location as the new physician, who the ancillary physician is to be billed under. Does this leave me liable if the ancillary physician was not there?

Any advice or help is so appreciated. Thank you!!

 

[thomas7331]

This situation was actually discussed in the legal forum at the recent AAPC national conference. Their advice was that services of an uncredentialed physician should almost never be billed under a different physician's credentials because they rarely meet the definition of 'incident to' which is intended for mid-level providers. I agree with this - unless you have instructions in writing from a payer that you can bill under a different physician, it's a risky practice as you're potentially misrepresenting the services.

If your physician has already seen patients, then your only really safe and compliant choice is to bill under that physician and accept the rejections or denials that you get. Your Medicare secondary payers may allow the secondary claims even if the provider isn't credentialed though. I'm not sure what you mean by billing the claim under one provider and using a different provider as the servicing provider? The claim level provider is the TIN to whom the benefits are assigned and that shouldn't change. I wouldn't manipulate the claims between the Medicare and the secondary payers again because you're putting yourself at risk of misrepresentation.

In my experience, the best practice is to know your payers' rules in advance and avoid scheduling new providers with patients whose payers won't cover the services before the credentialing is completed.

 

[Ilove2code]

Insurance Provider vs Service Provider

Thanks for your response. I was billing the claim as the ancillary doctor on site for that date as the Insurance Provider and listing the credentialed physician as the service provider showing that he performed the services?

 

[CodingKing]

Thanks for your response. I was billing the claim as the ancillary doctor on site for that date as the Insurance Provider and listing the credentialed physician as the service provider showing that he performed the services?

What do you mean by insurance provider vs servce provider? A physician cannot supervise a physican (other than in teching hospitals) so there should be no reference to the credentialed physican (maybe as referring?)

 

[sandrahlynne]

Credentialing

A lot of insurance company's pay out of network providers. If you have a provider out of network with insurance then communicate with the patient that info so they are not supprised to get a bill for out of network cost. I would never bill a physican under another physican. It's fraudulent. If the office knows they are hiring a new Dr. Then the office is responsible to communicate with credentialing staff to start getting them credentialed and added to groups contracts.