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Billing an MD under another MD's name

  1. Exclamation Billing an MD under another MD's name
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    My practice is considering billing a physician (that can't get credentialed for various reasons) under the name of another physician. What are your thoughts on this? Do you know where I may find documentation on this topic for my administration? I know that this is possible for a NPP to bill ‘incident to,' however, this is not the case. Please let me know and thank you in advance for your assistance.

  2. #2
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    This is not good. The only time you can bill an MD or DO under another provider is in a locum tenens setting. The scenario you are describing is fraud. You may want to check out the OIG website. A similar situation involving a dentist practice is listed on the enforcement actions page. December of 2006 if the link doesn't work.

    http://oig.hhs.gov/fraud/enforcement.../2006/1206.asp


    Good luck,

    Laura, CPC

  3. #3
    Location
    hibbing, mn
    Posts
    22
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    we do that here for our PA's we use the PA's for the service provider, and the MD for the billing because there is one ins that doesn't recognize the PA so this is fraud??????

  4. #4
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    PAs, NPs, and other midlevel providers can be billed incident-to an MD or DO you just have to be sure and follow any applicable guidelines.

    MDs or DOs can not be incident-to anyone else.

    Laura, CPC

  5. #5
    Location
    North Carolina
    Posts
    3,126
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    I have to agree with Laura. It is never appropriate to bill physician's services under another physician's provider number in his/her group. Back in the day, I credentialed physicians. The carriers (most) always emphasized that it was not appropriate to submit bills under another providers name.

  6. Default Billing MD under another MD
    Also, if you are audited pre payment, all claims will be denied because the billing provider did not provide the services billed and retrospectively you will be asked for restitution for the same reason.
    KP

  7. #7
    Location
    Greeley, Colorado
    Posts
    2,045
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    We actually bill new MD's to our practice under other credentialed MD's of the same specialty. We called each insurance that we contract with and verified this was ok. No, we don't do it for Medicare and Medicaid, we hold those charges until the provider is credentialed.
    Lisa Bledsoe, CPC, CPMA

  8. #8
    Default Does getting the ok from the carrier make it legal?
    From everything I can find it doesn't matter if the carrier is ok with this practice. The law is the law. do you have anything to the contrary?

  9. #9
    Location
    Greeley, Colorado
    Posts
    2,045
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    I don't. I actually asked my office manager about this when the post first appeared. She told me this was the way the practice works. Where can I find information to the contrary that it is not ok to submit charges under another provider number while waiting for credentialing? Obviously Medicare and Medicaid are different from private payers and that is what the manager is basing this practice on...
    Lisa Bledsoe, CPC, CPMA

  10. #10
    Default
    Where can you find billing instructions for these situations?

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