Practice Management Alert

In the last issue of Medical Office Billing & Collections Alert, you tried your hand at five billing questions in a quiz about multiple billing topics. Check your answers and determine whether you-re on the right track with topics like workers- compensation and the infamous birthday rule, or if you should crack open your books and take another look.

Hint: You can find all the quiz answers in one of these five past Medical Office Billing & Collections Alert articles:

Answer 1: False. When you-re billing for a provider in a group practice, if you now have a group ID, you will need a group NPI. If you-re billing for a facility, you-ll need a facility NPI. Each individual provider also needs his own NPI.

On the claim: For providers in group practices, enter the group NPI in box 33 on the claim form while entering the individual provider NPI in 24J.

Answer 2: The answer depends on the carrier and whether you want to get paid for the physician's services. You can have the patient privately pay if he is willing. If not, you need to check with the individual payer to see if you can bill for services.

The only payers that usually let you bill services before a provider is credentialed are Medicare and public aid. Medicare will pay your claims retroactively from the date of the practice's new physician's NPI application. Other payers give you an effective date for when you can start billing.

Beware: You cannot also bill services under another provider while you-re waiting for the new physician's credentialing.

Answer 3: No. Waiving copays or deductibles isn't a smart practice, regardless of the carrier. Financial arrangements that differ from the billing obligations laid out in your contract can result in fraud charges, penalties, and loss of carrier contracts. Discounts and waivers for Medicare or Medicaid beneficiaries should raise an even bigger red flag. If Medicare finds that you have submitted claims that misrepresent the financial arrangement you made with the patient, you could be facing imprisonment, criminal fines, civil damages, civil monetary penalties, and exclusion from Medicare and state healthcare programs. In this scenario, you should urge your physician to stick with the assigned copays.

Answer 4: New Jersey. The workers- compensation claim originated in New Jersey, so you need to follow that state's WC regulations for this claim even though the physician practices in New York.

Bottom line: Only one state has jurisdiction over a WC claim. You need to follow the rules of the state in which the patient originally filed the WC claim, which may or may not be the state where you practice or the state in which the patient lives.

Answer 5: False. While you should follow the birthday rule in this situation, "birthday" in the birthday rule refers to the month and day in a calendar year, not the year in which the parent was born. The birthday rule says that for a dependent child of parents who are not legally separated or divorced, the insurance of the parent whose birthday falls earlier in the year is the primary carrier.

-- The answers to the quiz were reviewed by Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.