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substitute billing

  1. #1
    Location
    Evansville Indiana
    Posts
    451
    Default substitute billing
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    We have several physicians whom we bill under one tax ID but they may or may not be at different locations. We are having trouble billing for "on-call" services. We want to bill under the regular physician's NPI so that he recieves payment not the physician who is covering. (this is for OB-gyn's for prenatal and delivery services mostly)Medicare guidelines state that if they are from the same medical group where claims are submitted in the name of the group you would bill with the substitute physicians NPI in 24J, however if you do this the claim will pay in his name and not the regular physician, which defeats the purpose of billing this way. However the guidelines also state that members of a group who bill in their own names are treated as independent physicians and this would not apply, you would put the regular physicians NPI in 24 J and use a Q5 modifier. Should we consider these physicians as independent since we are billing with their NPI even though we are using the same tax ID#? We are also questioning how to approach this same situation with Medicaid.
    I would appreciate any input.

  2. #2
    Location
    Evansville Indiana
    Posts
    451
    Default substitute billing
    Any Suggestions?

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