Legalities

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aprilrad65

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I would love to speak to a person who is well versed in the legalities of provider do's and don'ts. I am pretty sure what I am being told to do would be considered fraudulent and I am very nervous about continuing to do what the office manager is telling me to do. I think she is wrong and when I express that, I get pushback. I know that this is kind of vague, but if I can speak to somebody, I can make things clearer. It is with regards to a doctor being billed under another doctor.
 
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aprilrad65 said:
I would love to speak to a person who is well versed in the legalities of provider do's and don'ts. I am pretty sure what I am being told to do would be considered fraudulent and I am very nervous about continuing to do what the office manager is telling me to do. I think she is wrong and when I express that, I get pushback. I know that this is kind of vague, but if I can speak to somebody, I can make things clearer. It is with regards to a doctor being billed under another doctor.
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April
Look at modifiers GC and GR it is used with CPT code if attending provider/doctor is training the other doctor, but statement for the days treatment is on bottom of medical record by attending provider stating review documentation. I hope this helps you
Lady T
 
TThivierge said:
April
Look at modifiers GC and GR it is used with CPT code if attending provider/doctor is training the other doctor, but statement for the days treatment is on bottom of medical record by attending provider stating review documentation. I hope this helps you
Lady T
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Thank you for that, however, it is not a situation that the provider is training. He is a provider that had been sanctioned in other states for issues and is here now and because he cannot get credentialed or has been turned down by some insurance companies, they want to bill him under another doctor.
 
aprilrad65 said:
Thank you for that, however, it is not a situation that the provider is training. He is a provider that had been sanctioned in other states for issues and is here now and because he cannot get credentialed or has been turned down by some insurance companies, they want to bill him under another doctor.
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Hi, this certainly is a problem for the physicians at your group. The payer contracts probably have language that forbid this and whether or not the physician has been excluded from Medicare, it could endanger the practice's Medicare enrollment.

However, if you have concerns about your own legal risk you need to speak to an attorney. Not just because they know the law, but because if they're working for you, your conversation will be protected by attorney-client privilege.
 
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