Wiki regarding billing under supervising Dr

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monalisa

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I have a situation where the provider has midlevel providers and they bill the insurance under the doctor as Supervising. Which the insurance allows. It is my understanding that the doctor must be present in the office in order for the midlevel to bill for the patients they are seeing.
I need some clarification on this to prove to the doctor he must be in the office. Does anyone know where I may find this or am I wrong?
Thanks for any help.
 
These rules also apply to commercial insurances also am I correct? The office feels that with the commercial ins it is ok if he is not there.
I say no.
 
Probably depends on the carrier, I would look on their website or call them and ask.

We always follow the CMS guidelines for incident to regardless of payor so I have never checked with any of our commercials on this. The only office I currently have that this applies to is 85% Medicare/Medicaid sorry I can't be more help on the commercial side.

Laura, CPC, CEMC
 
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