Billing under another MD in order to get paid

aprilg44

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I currently work for a clinic that has a chiropractor, medical doctor, and a physical therpist. The DC is the owner of the clinic. He just announced that he is tired of not getting paid for services on UHC pts. He states that we must bill an office visit under the MD for coverage. I am very upset by this ideal. I do not feel it is legal. Can anyone help me. Is it legal? Can it be billed incident to?:(
 

Lorene

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It is not legal to bill this way. When you bill a payer under a physician's provider number services can only be for the physician or someone in his employ. The chiropractor's servivies are mostly not getting paid because they are not covered.
 

member7

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I agree with Lorene. It would be considered fraud for the chiro to bill under an MD or DO's number. He would be leaving himself open to audit in a hurry. Perhaps your chiro should seek more training in an area where he can get more profit. Check out the Medicare Claims Processing Manual or Benefit Policy Manual under the CMS website if you haven't done so.
 

007CPC

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Law & Ethics

I completely concur with Lorene. Situations like the one you are describing requires coders to transition there daily obligation to acting part lawyer. Behind every ethical conducted health facility there is a coder acting part lawyer, oracle, analyst, anatomist, physiologist, biller, coder; etc. (Quoted from writer Brad Erickson AAPC CODING edge magazine)

Don't be afraid to speak your voice--even when it shakes. When providers start breaking rules under one plan, most likely it will happen in the future to another;hence, opening themselfs and you to fraudulent charges. PUT the provider IN CHECK. Remember all MDs, DOs and DCs are scientist, and although seem adriot professionals in the medicinal business aspect, they could be real inept to the healthcare legal process; that is when a well educated coder in healthcare policy comes into play.

I would follow-up with what member7 says under the CMS website. Or contact the NAB of the AAPC.

Chad Malek, CPC, CCA
 
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