Practice Management Alert

Find out how you fared on last month's quiz 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: - "Write Off Patient Copays and Watch Your Revenue Plummet" (January 2007) - "Banish NPI Hassles With These Expert Answers to Your Top-4 Questions" (2007 Volume 7, No. 3) - "Decipher Carrier-Specific Processes for When a New Provider Signs On" (2007 Volume 7, No. 4) - "Take Your WC Claims From Stressful to Simple With These 3 FAQ Answers" and "Keep This Simple Chart Handy for Dependent-Child Billing Questions" (2007 Volume 7, No. 10). 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 [...]