Well it is confusing. The MD goes and see the patients and gives us the codes and we bill for him.
This is how it should be.
The hospital says that they bill for his services too
This is incorrect. The hospital does not bill for MD services, they bill for facility. Since the patient is already inpatient, they are already billing their portion (room&board, etc.). I would ask for a printout of exactly what they are billing for him.
(which I am not sure how that can be done, may be they use hospital tax ID), but the hosp Med Director told him to do his own billing too.
Same as prior - I don't know what they're doing either.
Now old EHR had psychology department (employees of the hospital in a different group in old EHR) and he was independant in EHR. New system shows that him as psych and the psychologist as neuro psych are together as (psych/neuropsych) in notes etc etc, psychology is called in earlier now (in past they were called after him) and now our billing here has more refusals than payments. He things that now psychologist notes as psych/neuropsych may have increased psychologist payments and the insurances are refusing to pay us.
I would need some specific denials to know what is going on. I really think you need to see what the hospital is billing. An MD and a PhD can see the patient the same day, but if the neuropsych happens to be an MD, and your psychiatrist is seeing the patient the same day, that might be a problem. Or it could be that if the hospital is billing the doctors as a group, then the services would be combined and billed as if one person performed them.
Can this happen? Can hospital do this without his permission? He asked an EHR staff who said, no they made sure that they did not have overlapping codes between him and the psychology department? What is this about? Psychologist codes should not be similar as his other than 90791 otherwise I cannot think of any other codes that could be common. But if this code is billed, he is MD and they are psychologist, then why do we get denial? Saying services already paid? Please help sort this out.
More and more, I think there are shenanigans afoot (showing my age now). The hospital needs to stop billing anything on his behalf immediately. They cannot bill for his services without his permission (which may have been on a contract he may have signed eons ago).
So here is my (suggested) plan of attack.
1. Write a letter to all parties
To Whom It May Concern:
It has come to my attention that there are other entities that are billing for services I have rendered. You are instructed to IMMEDIATELY stop billing for any services that I have personally provided. You are instructed to provide me with a detailed report of every service you have billed, in the last six months [insert however many months this has been going on] in my name, my license number, my tax ID number, and/or my NPI number, within TEN calendar days.
Should you fail to comply with either of these two instructions, I will consider you to be willfully committing insurance fraud, and I will take further action.
Be aware that I plan to investigate every service that I have billed that has been denied saying the services were already paid, and I fully expect the responsible entity to pay me for my services, or refund the money back to the insurance companies so that they may pay me directly for my services.
At this point, I assume this situation has come about due to ignorance and not fraud or malice; however, should the situation not be rectified immediately, one would reasonably assume the opposite.
2. Send this letter to a specific person at each, by certified mail with a signature, and cc it to anyone who is vaguely involved.
3. Be prepared for what is to come next - what will your plan be if they do not comply? Is he willing to report them for fraud? Is he willing to stop practicing there if they force him out? <-- if he's not getting paid, why would he want to work there anyway - they're stealing his income.
Good luck.