Practice Management Alert

Beware Submitting Claims for PIN-less New Doctors

If you-ve got a new doctor at your practice, you need to make sure she has her own Medicare provider number before you bill Medicare for any of her services. A medical office should never attempt to bill for services rendered to a Medicare recipient until the bill can be completely and properly prepared -- and this includes having the attending doctor's own provider identification number (PIN). 
 
Don't be tempted to bill for services under the PIN of another physician in the practice. Medicare considers this to be fraud, and it could lead to very serious legal consequences.
 
You must avoid improper billing by knowing misuse of provider identification numbers. The ID number of the provider who actually rendered the service to the patient must be inserted in the CMS-1500 billing form. 
 
The only exception applies to -incident-to- services under Medicare and other payer contract exceptions. To do otherwise could make individuals subject to the Federal False Claims Act.
 
Instead, hold the bill, and file the claim retroactively.    

Technically, the doctor without a PIN has been seeing the Medicare patients for free, but Medicare will usually allow you to back-bill for services beginning at the date you submitted a completed PIN application. This is a nationwide Medicare policy and is not dependent on the regional Medicare carrier. 
 
The real lesson here: Insist that new doctors coming into your practice have their PINs specific to your practice before they report for work.