Wiki Non Credential providers

[vpat28]

Hello.

Provider is hired and waiting to be credential then Can he/she see the patient and bill under the provider who is credential ?

If not what is the other option for non credential provider...

 

[thomas7331]

If 'incident to' requirements are met (and the payer allows 'incident to' billing), then a provider may bill those services under the a supervising provider's credentials. Otherwise no, you cannot do this, unless you have written authorization from a payer telling you they will allow it.

If your new provider is a physician, and not a PA or NP, then most likely they are not practicing 'incident to' and they should not bill under a different provider - to do that would be fraudulent. The compliant options are to bill the services under their own credentials (understanding that this may cause denials and out-of-network payments) or to have that provider only see patients who carry the insurances with which the provider has already been credentialed.

 

[csperoni]

This topic comes up periodically in the forums.
General guidance: Unless billing incident to (which has specific requirements), you may not bill 1 clinician under another clinician.
Here was my response to another post:
The guidelines/references are likely in your provider contracts with each payor. I don't think I've ever seen a contract that would permit billing under a different physician.
In our practice, we have a 1 year training program (not an official fellowship) for fully certified ob/gyns to gain experience in complex pelvic surgery. It's a new clinician every year. I start the credentialing process 90 days before they first step foot in the door. Even 90 days is not enough for some carriers.
My opinion when hiring a new physician:
1) Start credentialing as early as possible.
2) Once they start, keep a chart of which carriers they are credentialed with. Update it regularly and keep your scheduling staff informed.
3) Only schedule patients for the new provider with fully credentialed carriers (or self pay).
4) To keep the new provider's schedule fuller, have your front desk funnel the credentialed payors to the new physician as much as possible.
Other options include having the new clinician provide global surgical care (postop, suture removal, etc.) In our practice, during the week we round on inpatients in the morning and afternoon. The new clinician could do one of those roundings, and the bill can be submitted under the participating clinician who also saw the patient the same day.
5) There may be instances where (for patient care reasons), you must schedule a patient with non-credentialed insurance. Inform the patient (in writing is a good idea) the new physician may not currently be participating, and they may be billed for out of network deductible/co-insurance, etc.