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dosobill

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:confused::confused:Our orthopedic surgeon group is adding a new provider who is a physical medicine and rehabilitation physician. The new physician will start in August. The billing manager hasn't finished the credentialing process for the new provider. She is wanting to bill the new provider charges under one of our orthopedic surgeons NPI#. I told her no because the charges will not be incident to. Am I correct??? Please help!!!
 

Herbie Lorona

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Yes I don't believe most insurances would allow that. If it is Medicare they do back date I believe a month so even if its not done you can see them and still get paid once it is complete. Your best bet would be to check with each insurance they want to have the provider see while they are not credentialed.
 
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You can't bill the services of one physician under a different physician's name or NPI. Period. That's flat out fraud, in every sense of the word. CMS is VERY strict about this. An exception would be locum tenens, but that's not applicable in your case. And it's obviously not a teaching facility, so there's no "Resident" "Supervising Physician" situation. And you are correct, you can't use incident-to either because the provider is not mid-level (PA, ARNP, etc). Incident-to only applies to NON-physician practitioners.

If you get audited, the documentation versus the billed charges won't match and that's not something you want to mess around with. That type of violation can nail the office with possible exemption from all government programs, fines, perhaps prison time if they want to be especially harsh, including YOU. If I were you, I'd flat out refuse to participate and avoid that at all costs.

https://www.cms.gov/Outreach-and-Edu...eet_905645.pdf

https://www.cms.gov/Outreach-and-Edu...ads/se0441.pdf
 
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