sempson
Contributor
Our provider gave his own children immunizations and put the visit under another provider. He wants me to bill this visit to his insurance. This does not sound correct.
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Wiki Provider billed insurance for giving own children immunization shots
- Thread starter sempson
- Start date
thomas7331
Guest
If the other provider whose name is on the claim was not involved in this service, then you're right, this would not be correct coding or billing. However, if that other provider has documented having supervised the service and is taking medical responsibility for it, and your provider is just administering the vaccinations, then it could technically be classified as an 'incident to' service and might be OK to bill this way.
Many insurance companies will not reimburse claims for services to family members. If the provider is causing incorrect information to go on the claim in order to obtain payment that he wouldn't otherwise be entitled to, then this could be considered fraudulent.
Many insurance companies will not reimburse claims for services to family members. If the provider is causing incorrect information to go on the claim in order to obtain payment that he wouldn't otherwise be entitled to, then this could be considered fraudulent.
CBLENNIE
Expert
I work for an insurance carrier, and it is a fairly standard in exclusion in our policies to deny charges for treatment provided by a family member or a member of the patient's household. If your provider administered the immunizations to their children and requesting the service be billed to the insurance company by another provider in their practice and the insurance carrier finds out they are likely going to investigate the claim(s) and possibly adjust the claim(s) to deny and recoup any payments made for these services. Doing this is a great way to get on the insurance carrier's radar for possible audits of all claims for their family members, which were submitted for services billed to the carrier by the provider's practice.
A physician can't be "incident to" another physician.
It is only applicable for non-physician providers billing under a physician.
thomas7331
Guest
That's not entirely true. Any employee of the practice who is carrying out, under supervision, the care plan of one of the physicians is performing 'incident to' services, and that could include another physician. Because physicians are not trained to practice this way, it's generally not advised to do this, but it's not impossible. This question was actually discussed at length in the legal session at the AAPC Healthcon a number of years ago.
@sls314 - as @thomas7331 stated, it is permitted to bill one physician incident-to another physician. But it's usually a really bad idea. Physicians typically act independently and are not simply carrying out the orders of another physician. https://www.aapc.com/blog/26668-risks-abound-for-non-credentialed-physicians-using-incident-to-rule/
Regarding the original question - here's my 2 cents. If Dr. A gave the flu shot to his kids, I would not bill under Dr. B as a way of getting around receiving payment for treating family members. It's too much of a gray area involving compliance and legal issues to risk it. I would use this as an education tool. In the future, if a Dr. A wants to treat their immediate family members, provide it as a free service, or have another clinician in the practice treat them.
Regarding the original question - here's my 2 cents. If Dr. A gave the flu shot to his kids, I would not bill under Dr. B as a way of getting around receiving payment for treating family members. It's too much of a gray area involving compliance and legal issues to risk it. I would use this as an education tool. In the future, if a Dr. A wants to treat their immediate family members, provide it as a free service, or have another clinician in the practice treat them.