Wiki New provider credentialed but not associated with our practice yet

[edennis34]

We have a new provider that left a local practice to join ours. He is credentialed with the insurances but is in the process of being credentialed with our practice. No one told me his credentialing was incomplete so I've been billing under his NPI w/our tax id# since he started. We are starting to receive some denials. I can't bill under a different billing provider can I? My manager says yes but my gut says no. Any input would be greatly appreciated!

Emily

 

[jorellana42]

We had the same issue with several new providers in our practice. We can not bill under another provider's NPI. Unfortunately these claims may have to be written off.

 

[Pathos]

We had the same issue with several new providers in our practice. We can not bill under another provider's NPI. Unfortunately these claims may have to be written off.

Agreed. If the new provider is an MD/DO, and not a NP/PA, then you cannot bill under another provider's NPI. The frustration adds another layer when different insurances take different time to get providers credentialed too. We have a full time person whose main job function is to ensure provider credentialing. It's that important, since you won't get reimbursed by insurance that the provider is not credentialed with.

NPs/PAs might get away with billing Incident to, but sounds like your provider don't have that option (if they are MD/DO).

Writing off the uncredentialed charges seem to be the only way.

 

[CodingKing]

I know CMS allows NPP to bill incident to another NPP, but I don't believe an MD can bill incident to an MD. Anyone who attempts to interpret this as MD billing incident to another MD still need to recognize that all of the other incident-to guidelines need to be met. I'm sure most auditors will have a problem if the performing provider is not an NPP, so its probably not a smart idea to do this without consulting the practice attorney.


https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNMattersArticles/downloads/se0441.pdf

Note: “Incident to” services are also relevant to services supervised by certain nonphysicianpractitioners such as physician assistants, nurse practitioners, clinicalnurse specialists, nurse midwives, or clinical psychologists. These services aresubject to the same requirements as physician-supervised services. Remember that“incident services” supervised by non-physician practitioners are reimbursed at 85percent of the physician fee schedule. For clarity’s sake, this article will refer to“physician” services as inclusive of non-physician practitioners.

 

[cgaston]

All is not lost! When credentialing you can ask for the start date to begin the day the MD began seeing patients.

I am not sure if all carriers will, but I remember our Credentialing person asking for the start date to begin on "X/X/XX" when they were on the phone. Good luck!

 

[MrLittlefoot]

Call the insurance and ask

I've worked some places that would retroactively credential providers to the date they started in your practice. I've also worked places that wouldn't. But it never hurts to find out for sure. Also, i'm not sure why you would have to write off the bills entirely for every patient. Even if they won't retroactively credential your provider, you could still submit claims under the new doctors name and see if the patient has out of network benefits. In the name of customer service you probably shouldn't charge the amounts that were over the fee schedule to the patient if they thought they were seeing a doctor in their network and instead write off the difference so they only pay what they would have paid if the doctor was credentialed and in network. But some money is better than no money.