Part B Insider (Multispecialty) Coding Alert

Question: The doctors I work for asked me to bill a radiology procedure under the "on call/house" doctor rather than the doctor who ordered and performed the service because the ordering doctor is out of network with the patient's insurance company. They think because they are all in the same practice we can bill services under whichever doctor they want within the practice. Is this correct?

Answer: Your doctors are not correct. You cannot bill under any doctor within a practice simply because they all belong to the same practice. You would be billing for services the doctor did not provide. The on call doctor did not provide the radiology procedure so you should not bill as if he did. That qualifies as fraudulent billing, especially if you're doing it to get around out-of-network issues.

You'll bill under the group ID number, but use the national provider identifier (NPI) of the doctor who performed the procedure -- not a physician in the practice you designate as "on call" or as the "house" doctor.