Legal Question

medcode12

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A physician is new to the practice and is in the process of being added as a participating provider with insurance companies. Is it illegal to bill services under an already participating provider of the practice if he/she okays it? If not, should the new physician not start rendering services to patients until he/she is a participating provider with ins. comapnies? I'm new to coding and just wanted to know the guidlines for billing under new physicians who are not yet participating providers.
 

Serenity6266

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Absolutrely illegal to bill under another physician

If you look at any HCFA FORM THERE IS A LEGAL AFFADAVITT for the RENDERING physician. The rendering physician is also the physician whose NPI is associated with the charges. The physician you would be billing under IS NOT THE PHYSICIAN who "actually" rendered the services. This would be considered fraud. I am a consultant and have represented at least five practices who made this same mistake. The last time I went to a legal proceeding befor the Federal Attorneys in NYC with a physician whose staff did the same thing-and on a Medicare claim no less. I STRONGLY suggest you not do this.

If anything, wait until this physician is properly credentialed-ask the carriers to list his/her participation retroactiely-they can do that. When you have confirmation of their par status then submit the claims. If not, you are exposing your practice to a fraud charge/audit.
 

Serenity6266

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Absolutely illegal to bill under another physician

If you look at any HCFA FORM THERE IS A LEGAL AFFADAVITT for the RENDERING physician. The rendering physician is also the physician whose NPI is associated with the charges. The physician you would be billing under IS NOT THE PHYSICIAN who "actually" rendered the services. This would be considered fraud. I am a consultant and have represented at least five practices who made this same mistake. The last time I went to a legal proceeding befor the Federal Attorneys in NYC with a physician whose staff did the same thing-and on a Medicare claim no less. I STRONGLY suggest you not do this.

If anything, wait until this physician is properly credentialed-ask the carriers to list his/her participation retroactiely-they can do that. When you have confirmation of their par status then submit the claims. If not, you are exposing your practice to a fraud charge/audit.
 

medcode12

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I thought so. Just wanted an opinion from someone more experienced. Thank you so much!
 
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