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Wiki Referring Providers

ssirsky

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Lehighton, PA
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We've been having claims get denied since we started billing with referring providers on the claim. We used to bill with our rendering doctor as the referring and a few months ago started entering the referring provider as the physician who referred to our practice. Most of our referrals come from optometrists since we are an ophthalmology specialty practice. It looks like it's always Medicare denying and generally on testing charges like 92134. Is there a problem with billing claims with the rendering/referring physician as the same doctor? Unsure why it would be a different field on the claim if Medicare wants it to be the same provider anyway. We would probably do it uniformly across the board as well, if we have to go back to billing that way for Medicare patients.
 
CO183, MA13, N574
As far as I know, optometrists are a provider type that Medicare recognizes as able to order services. However, referring providers must also be enrolled in Medicare - if you're using an optometrist who isn't enrolled in Medicare as your referring provider, that could be causing the denial. Also, you'll need to make sure you're using the correct NPI for the referring physician - it needs to the individual NPI, not the group's NPI.
 
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