Wiki Credentialing and Proper Billing

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kslade1

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My practice is merging with a larger practice on 03/01/2016. we were told this last week...the incoming practice is saying that our Therapist who will remain for the next few months will still be seeing patients however we must bill under a therapist that is already credentialed to the new group. For Medicare I know this could be a few months to actually remove him from one group to the other. Is it legitimate to have this therapist services billed under another therapists NPI? It was my belief that all of the credentialing and reassigning of benefits must be completed before billing can be done. In addition the facility that is taking over has not added this location to their practice via a 855R....Yet they are telling us that this is what we are to do....Does anyone eles out there find this disturbing?
 
kslade1 said:
My practice is merging with a larger practice on 03/01/2016. we were told this last week...the incoming practice is saying that our Therapist who will remain for the next few months will still be seeing patients however we must bill under a therapist that is already credentialed to the new group. For Medicare I know this could be a few months to actually remove him from one group to the other. Is it legitimate to have this therapist services billed under another therapists NPI? It was my belief that all of the credentialing and reassigning of benefits must be completed before billing can be done. In addition the facility that is taking over has not added this location to their practice via a 855R....Yet they are telling us that this is what we are to do....Does anyone eles out there find this disturbing?
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I've been researching a similar topic, but for different reasons, and found that a therapist cannot bill under another therapist's NPI, for any reason. They can either wait until the credentialing process is complete, or possibly bill incident to one of the physicians onsite, depending on whether or not the payers involved follow incident to guidelines.
 
What kind of therapists are you referring to? I too understand this to be that they have to be credentialed before providing services. I am throughly researching this also. Any feedback is very much appreciated!
 
jennamiller said:
What kind of therapists are you referring to? I too understand this to be that they have to be credentialed before providing services. I am throughly researching this also. Any feedback is very much appreciated!
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I assumed the OP was referring to Physical and/or Occupational Therapists. That is the provider types that I was doing research for.
 
I'm doing research on psychotherapist, LICSW's. I would think the OIG is referring to all providers. Do you have any insight? My understanding is that for all fully licensed providers, IE their board has licensed them to work independently, that agency's are required to credential with the payers before they care provide services. Unless their payer contract says otherwise. Most payers require credentialing as the OIG refers.

TIA
 
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