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Thread: billing for a doc prior to finishing Medicare app.

  1. #1

    Default billing for a doc prior to finishing Medicare app.

    AAPC: Back to School
    Is there a way to bill under a current MD's billing NPI for an MD who is joining our call group but doesn't have his Medicare application processed yet? I looked at the Q5 and Q6 modifiers but he would be seeing his own patients, not my doc's so I don't think that seems legal.

  2. #2
    Join Date
    Apr 2007
    Athens, Ga.


    I do credentialing for my practice as well as coding, and this is what normally happens. When Medicare approves his application, the effective date would be the date he started work at your clinic. You can then go back and bill all his charges that were performed on or after this date of service and Medicare will accept the claims. Basically, you have to "hold" all his claims until he is accepted, then go back and bill them.

    This will NOT work for commercial payers, however, because they do not "back date" their effective dates. Any DOS prior to the physician being accepted into the group will process according to the patients out of network benefits.
    Walker Bachman, CPC, CPPM

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