Wiki Rendering provider vs. billing provider

[Jennifer Bataille]

I am new to a practice that is a primary care clinic open 7 days a week. There are two physicians for patient care. One is the owner, the other an employee. Owner physician is credentialed with accepted insurance plans, employee physician is not credentialed. No credentialing applications have gone out so there is no pending credentialing approvals.
Since this is not a locum tenens situation (beyond 60 days) how can we bill when employee physician is performing services? Can Line 24J have rendering provider NPI (employee physician) and Block 33 have billing provider NPI (owner physician)? Any special documentation in the medical record required?

 

[MARYELLENG]

I WAS ADVISED TO BILL UNDER THE OWNER'S NUMBER WITH A Q5 MODIFIER

 

[csperoni]

I definitely do not agree with the advice to use Q5 as that code has requirements that I feel do not fit your situation. For example, 60 days or less, & physician should not be in the same group and specialty.
Any practice I have ever worked at, as soon as a new clinician was being hired, even before employment start date, sent out insurance credentialing. That would be my general recommendation. I unfortunately do not know how to solve your problem in the meantime, but I don't think Q5 is the answer.

 

[rachaelwilleford]

To my knowledge you cannot bill the employee physician as an in network provider at this time. You would have to advise the patient's the Physician XYZ is not in network prior to service and it's best if they sign an acknowledge of notification of such. Once credentialing packets are gone out, you may be able to hold the claims (depending on the plan's policies for credentialing) and bill once you get notice of in network status, but that can take up to 90 days.

You would still bill employee physician as rendering. They will review with that physician and pay on his/her status.

 

[haraml7]

I am new to a practice that is a primary care clinic open 7 days a week. There are two physicians for patient care. One is the owner, the other an employee. Owner physician is credentialed with accepted insurance plans, employee physician is not credentialed. No credentialing applications have gone out so there is no pending credentialing approvals.
Since this is not a locum tenens situation (beyond 60 days) how can we bill when employee physician is performing services? Can Line 24J have rendering provider NPI (employee physician) and Block 33 have billing provider NPI (owner physician)? Any special documentation in the medical record required?

This sounds like an "incident to" scenario. This would depend on the insurance company, state rules and what procedures, if any, are being performed.

The rendering provider would have to bill out of network if he is not wanting to become credentialed. If you bill the owner as the supervising physician some insurance companies will process this as the owner providing the services, and from what I understand the owner is NOT the rendering provider.

Is the employee a student?

I hope this helps a little.