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.
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.
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.A physician can't be "incident to" another physician.
It is only applicable for non-physician providers billing under a physician.