Wiki Multispecialty Group Billing - for Cardiology, Ultrasound

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losborn

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We have a multispecialty group where one doc is the PCP and submits all claims under his provider ID no matter which specilaist actually performed the work. The result is that our PCP is billing for Cardiology, Ultrasound, Dx Rad, etc.
All payments go to the Tax ID of the group practice.

I was taught that the MD who did the procedure is the one who signs the 1500. Are there some group rules I don't know about? Is this illegal or just poor practice?

Thanks,

Lin
CPC
 
So...this provider is billing and receiving credit for services he did not perform?

I never like to assume so let me ask a question about your 1st example. You have a cardiologist in the group (?). This specialist performs an E/M visit (?)....is the claim submitted with the name of the PCP and his NPI?
 
Not exactly. The PCP does an E/M and bills it, but also submitted on the same day are proceedures done by other specialists in the group (no E/M) but everything is billed on the PCP's provider ID.

Lin
CPC
 
I work for a multispecialty clinic and whoever performs the service is the one we bill under. It is their name on the 1500. For example - If Dr. A performs and E/M and Dr. B does and ekg - Dr. A sends out a 1500 with the e/m he performed and Dr. B sends out a 1500 with the ekg he did. It would not be legal in my opinion to bill both under Dr. A since he did not actually perform both services. Hope this helps!
 
Multispecialty

I too work for a multi-specialty group and some of the insurance companies handle this better than others. A suffix is attached to our tax id with Horizon to show the difference between a primary care physician and a specialist.
Others just pay based on the submitting NPI of the individual practitioner.
 
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