Inpatient Billing not done by doctor seeing patient

gina_marie

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I have a question - I tried to google it but can't seem to find anything concrete.

A physician that I do billing for sees patient's in the hospital. He is the one that signs the charts, sees the patients. Apparently, he is part of a "group" of physicians that see patients that are admitted to the local hospital. Sometimes, they ask me to bill the charges under his wife's name (who is also a physician) because she is the "Head" of the group that sees the patients. I always put his name as the physician though because he is the one that signs off and sees the patient.

Earlier, his office manager calls me and tells me "It is perfectly legal to bill under <doctor name> because she is the head of the group...". Does anyone know if this is true? I told her I would like to see that in writing and she told me she would have the physician call me when he came into the office. I haven't found a good resource that I can use to prove I am correct, so maybe I am not? If anyone has any insight on this, it would be greatly appreciated!

Thanks.
 

mitchellde

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The rendering provider must be the NPI in 24J and the signature on line 31 must correspond to that NPI. The NPI on 33A is the NPI of the practice. At no time can you use an NPI on 24J that is not the rendering or the supervising provider. A supervising provider must be the provider in the immediate area while the patient is being attended to. So the question is why would they want you to bill under the wife doctor and not the rendering doctor at any time?
As far as how to prove you are correct? Look at the instructions for 24J it states rendering/supervising provider.
 
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mitchellde

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Item 24J: Enter the rendering provider’s NPI in the unshaded portion. In the case of a service provided incident to the service of a physician or non-physician practitioner, when the person who
ordered the service is not supervising, enter the NPI of the supervisor in the unshaded portion.
NOTE: Effective May 23, 2008, the shaded portion of 24J is not to be reported.
Item 31: Enter the signature of the provider of service or supplier, or his/her representative, and either the 6-digit (MM/DD/YY) or 8-digit date (MM/DD/CCYY) date, or alphanumeric date (e.g.,
January 1, 2007) the form was signed.
In the case of a service that is provided incident to the service of a physician or non-physician
practitioner, when the ordering physician or non-physician practitioner is directly supervising the service as in 42 CFR 410.32, the signature of the ordering physician or nonphysician practitioner shall be entered in item 31. When the ordering physician or nonphysician practitioner is not supervising the service, then enter the signature of the physician or non- physician practitioner providing the direct supervision in item 31.
NOTE: This is a required field; however, the claim can be processed if the following is true.
If a physician, supplier, or authorized person's signature is missing, but the signature is on
file; or if any authorization is attached to the claim or if the signature field has "Signature on
File" and/or a computer generated signature.
Item 33a : Enter the NPI of the billing provider or group.
 

RebeccaWoodward*

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"Incident to" does not apply to inpatient setting.

Hospital or SNF

For inpatient or outpatient hospital services and services to residents in a Part A covered stay in a SNF the unbundling provision (1862 (a)(14) provides that payment for all services are made to the hospital or SNF by a Medicare intermediary (except for certain professional services personally performed by physicians and other allied health professionals). Therefore, incident to services are not separately billable to the carrier or payable under the physician fee schedule.

http://www.cms.gov/MLNMattersArticles/downloads/SE0441.pdf
 
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