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Thread: Question about coding and billing for covering physicians...

  1. #1

    Unhappy Question about coding and billing for covering physicians...

    AAPC: Back to School
    I am in a bit of a bind and I am hoping someone can help me.

    The physician I bill for had another physician from another practice cover while out for vacation for 2 weeks. They made arrangements that the physician covering would bill out the claims. This physician's office billed the claims out from their practice and coded them as New Patients. Also, they forwarded face sheets with the patients info to us to collect the copay amounts. Then they billed my physician in addition to all this...

    -First, I'm confused as to why they made this arrangement as it seems to me that we would bill these out like we always have done.
    -Secondly, my question is shouldn't they collect the copay since they already billed the claims.
    -Thirdly, shouldn't they be coding what the regular physician would code (established).
    -Lastly, if the above is actually true and they can do this, why are they billing my physician when they have already received payment from these parents' insurance? This does not seem right to me...

    Thanks in advance!
    Last edited by sunchips; 12-01-2010 at 11:39 AM.

  2. #2

    Wink problem w/ covering MD

    First, NO they cannot bill as new patient visits. If there was an agreement to cover they must bill as established patients. This agreement can be verbal or in writing...hoping it was in writing.

    Second...they need to bill the patients for their copays if they did not collect them. That is not your responsiblity. That would reflect as revenue to you that you never actually billed for... that could constitute fraud????

    Third...They should not be charging for covering your practice if that was not agreed upon to begin with...that shouldn't happen anyway.

    Hope this helps....

  3. #3


    Thank You so much! I figured as much because if it doesn't feel right in the billing/coding world then it more than likely isn't. Your input helps a lot thank You for commenting!

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