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Thread: Urgent assistance required!

  1. #1
    Join Date
    Apr 2007
    Location
    Murrieta, CA
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    79

    Default Urgent assistance required!

    Promo: Code Books
    Dr. A is established with Medicare and other PPO's. Dr. B is beginning to see patients while Dr. A. is on premisis, but Dr. B. is not credentialed with the carriers yet. The applications are in process but as we all know...it takes FOREVER!!!

    How can I bill Dr. B's patients under Dr. A's credentials while we're waiting for the approvals?

    Does Dr. A always have to be present ON SITE when Dr. B sees patients?

    Can Dr. A just review the records without being on premisis with Dr. B?

    Thanks

  2. #2
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,168

    Default

    you cannot bill Dr. A under Dr. Bs number. There is a regulation on this somewhere. If you check with the payer they will more than likely tell you the same ting. Every one I have ever asked have emphatically said no this cannot be done. Dr. B will have to wait to be credentialed or all patients he sees will have to be established patients seen as a shared encounter where Dr. A will have see the same patient on the same day and provide his own assessment note.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Join Date
    Apr 2007
    Location
    Murrieta, CA
    Posts
    79

    Default

    The only other option is the PPO patients are billed out of network and we don't want to do that! The credenitaling is taking forever because we are having to change from a single provider to a group and there's new contracts that are being drafted...to the carriers advantage, of course! Then they won't even get things going until the group contract is signed.

  4. #4
    Join Date
    Apr 2007
    Location
    Columbia, MO
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    12,168

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    I understand but you will have to bill out of network. And you must inform the patients prior to their encounter that this provider is currently out of network . If the patient refuses then you need to reshedule with the in network provider.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Join Date
    Apr 2007
    Location
    North Carolina
    Posts
    3,126

    Default

    If he see's a MCR patient, you'll need to hold his claims until he receives his MCR number. Hopefully, those claims that are released will be within the time frame that retro billing will kick in.

    16=• Knowing misuse of provider identification numbers, which results in improper billing;

    16 An example of this is when the practice bills for a service performed by Dr. B, who has not yet been issued a Medicare provider number, using Dr. A’s Medicare provider number. Physician practices need to bill using the correct Medicare provider number, even if that means delaying billing until the physician receives his/her provider number.

    Page 6

    http://oig.hhs.gov/authorities/docs/physician.pdf

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