New Provider Hired in our Practice.

karolynak

Contributor
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I have a new provider in our practice. My management staff wants her to start seeing patient's even though her set up is not completed with our PPO contracted insurance companies. Can I bill shared work under a different MD if that provider see's the patient's as well and writes an attestation in the note that they concur with the diagnosis and treatment plan. Most things I have read are talking about a mid-level and an MD sharing work. My understanding is Incident Too would not be appropriate either as they are the same level of provider.
 

trarut

True Blue
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689
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Columbus, OH
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No, that would be billing incident-to between providers which is not allowed. Nor is split/shared visits between providers. You need to limit the provider to plans they are credentialed with or accept that you're providing free care to the patients s/he sees.
 

csperoni

True Blue
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Selden
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This topic comes up periodically in the forums. As stated above, you may not bill under another physician.
Here was my response to another post:
The guidelines/references are likely in your provider contracts with each payor. I don't think I've ever seen a contract that would permit billing under a different physician.
In our practice, we have a 1 year training program (not an official fellowship) for fully certified ob/gyns to gain experience in complex pelvic surgery. It's a new clinician every year. I start the credentialing process 90 days before they first step foot in the door. Even 90 days is not enough for some carriers.
My opinion when hiring a new physician:
1) Start credentialing as early as possible.
2) Once they start, keep a chart of which carriers they are credentialed with. Update it regularly and keep your scheduling staff informed.
3) Only schedule patients for the new provider with fully credentialed carriers (or self pay).
4) To keep the new provider's schedule fuller, have your front desk funnel the credentialed payors to the new physician as much as possible.
Other options include having the new clinician provide global surgical care (postop, suture removal, etc.) In our practice, during the week we round on inpatients in the morning and afternoon. The new clinician could do one of those roundings, and the bill can be submitted under the participating clinician who also saw the patient the same day.
5) There may be instances where (for patient care reasons), you must schedule a patient with non-credentialed insurance. Inform the patient (in writing is a good idea) the new physician may not currently be participating, and they may be billed for out of network deductible/co-insurance, etc.
 
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