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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!!!:confused:
 
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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-Ed...edicare_FandA_Physicians_FactSheet_905645.pdf

https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/se0441.pdf
 

dosobill

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Thank you that what I thought. Sorry I worded the incident to incorrectly. I was telling the billing manager that it wouldn't work either. Thank you for your help.
 
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dosobill

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How can I protect myself is this situation because they don't want to listen to me?? My name isn't on claims etc until the payment comes in and I post the payment.
 
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Your name is attached to anything you do when you're access a patient's chart electronically. The system is set up to do that as an audit trail. You can contact an internal compliance office (if you have one), escalate it to the head of the clinic, anyone higher up on the food chain basically. I would think there has to be someone above the billing manager.
 

sab001

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How can I protect myself is this situation because they don't want to listen to me?? My name isn't on claims etc until the payment comes in and I post the payment.

If your practice has a compliance hotline, you can report your concerns in that manner. This will accomplish a couple of things. First, the concerns will be documented and a review can begin. Two, there is likely a non-retaliation rule for reporting you so are protected. If your practice does not have a compliance hotline, you STILL HAVE A DUTY to report the alleged fraud. You can do so by visiting oig.hhs.gov/report-fraud or call 1-800-HHS-TIPS. The fraud is triggered by the billing manager's knowledge of the right thing to do and ignoring that advice by filing a false claim for purpose of reimbursement.

Clinical notes is the proof. If the PM&R doc is the one that completes the notes but you bill under another provider, that is a false claim.

Protect yourself by documenting facts (not speculations) and date/time those documents. Be prepared to see an attorney's advice if necessary.

S Burk
 
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