Supervising Physician Requirements with Regards to Billing

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Hello,

I am new to the billing/coding world. I've been coding and billing for workers compensation and have some questions.

I work for an urgent care in CA with 1 supervising physician and many NP/PA/Locum providers. When billing, the 1500 has the supervising physicians name/NPI in box 17. He is also reviewing and sign ALL workers comp medical records (after its already been locked by the rendering provider) before sending in the bill. This is unrelated to the 30% he regularly reviews and signs off on. This creates a bottleneck in sending the bills. I'd like to learn ways to make this process go smoother.

- Is there a general rule for whether or not the supervising physician also must sign the MR if the name/NPI are already in box 17 of the 1500?
- If this is not a rule but a carrier decision, do you know of the carriers that require his signature must also be on the MR?
- Do you have a link from a website I can read through this information?

Corvel, particularly, has been specific in their requirement of having the supervising physician also sign the MR in addition to box 17 on the 1500. But, I cannot find any literature on the subject.

Any help is appreciated!
 

TThivierge

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Workers Compensation Attending Docs with NP or PA

Hi There

I did worker comp in Ohio and VA. Each state is a bit different. But I would list the attending doc name on claim if he is consulted or assisting the Phys Assistant(PA) Nurse Pracitioner (NP) or hospitalist. MD usually only one can bill worker comp cases,but document the treatment completed by NP, PA and have MD sign it or review it on the treatment for the day on the bottom of the record.

Reviewing the CMS 1500 fields 17 A list the NPI of treating professional doc, box 19 you could add more info of name and the NP or PA name who treated the WC patient/enrollee. Box 31 on the CMS 1500 is for the attending provider and his NPI # in field 33.

Also you know to put the SS # , date of original injury, claim # assigned to patient from worker comp. agency on claim, right? Does the state of CA enforce the patient WC injury be used , same dx code each time on WC claims? Ohio did that with W claims. We use to have the dilemma of the patient would want see doc for injury and a new illness....we made doc do separate records despite being on same date. We'd bill commercial insurance for illness and WC follow up/recheck to the WC agency.

Also each doctor had special number thru credentialing process under the WC agency in the state.

i hope this helps you
Lady T
 
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