Neurology & Pain Management Coding Alert

Question: We have a new doctor who does not have her Medicare or other provider numbers yet. The main doctor in the practice wants her to start seeing patients. Medicare has told me we can let her see patients (because her Medicare number is retroactive to her date of license), but we should hold the bills until we have her provider number. Another doctor says we can bill under the main doctor's number if he peeks in and signs the chart when the new doctor sees patients. Whose advice should I follow?

New Jersey Subscriber

Answer: When you're deciding who or what is more reliable, another physician or Medicare guidelines, always take Medicare's word for it - you should hold her claims.
 
The new physician cannot submit claims for reimbursement from Medicare or other payers until she has received approval, either issuance of a number by Medicare or notification of being credentialed by other payers.
 
Once the new doctor has filed for her Medicare number, she can see Medicare patients, but you should hold all claims for services provided until she has received her Medicare number. Be sure to ask your individual carrier if it has additional or different requirements.
 
Ask your other third-party payers for their policies on how a new physician receives credentials and when the doctor can start providing care for patients who have coverage through that insurer.
 Incident-to rules do not apply in this situation. The established physician cannot submit a claim under his Medicare number for services provided by the new physician even if the established physician briefly sees the patient or signs the medical record.

 - Clinical and coding expertise for You Be the Coder and Reader Questions provided by Neil Busis, MD, chief of the division of neurology and director of the neurodiagnostic laboratory at the University of Pittsburgh Medical Center at Shadyside, and clinical associate professor in the department of neurology, University of Pittsburgh School of Medicine; and Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J.