Billing All Mid-Level Providers Under the DOC
This may sound like a ridiculous question to some of you, but this has become a dilema with my organization and I need guidance, please.
In terms of billing, I understand that there are some payers out there that will not credential or recongize a mid-level provider and in order to report those services we have to bill under the supervising physican and append the modifier SA so the payer will process the claim correctly and the carrier will reimburse at the correct level (usually 85%). Now the problem, my organization is asking if we can apply this methodology to all mid-level providers. Meaning can we bill all mid-level providers under the supervising physican and append the SA modifier across the board, or do would we open ourselves up to potential denials? Legalities? We do understand that Medicare does not accept the SA modifier. My understanding of the reimbursement process is that if the provider is credentialed with the payer and has his/her own number, you are to bill that provider under his/her own number.
So, can anyone advise me on this issue, please? I think we can't do this across the board, but I am getting pushback. All thoughts appreciated.
Last edited by dballard2004; 08-26-2011 at 02:33 PM.
Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P