You Be the Coder:
Billing During Credentialing
Published on Mon Oct 01, 2001
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: We recently hired a new radiologist who wants to begin billing immediately, even though he hasn't completed the credentialing process with insurers. Can we submit claims for services he has provided under the name of another physician who has been with the practice for a while and is already credentialed?
Virginia Subscriber
Answer: It is never acceptable to bill services provided by one radiologist under another physician's name or provider identification number. Billing under the name of a physician who did not perform the service could lead to allegations of false claims submissions.
Instead, the radiology practice should hold all claims that require an individual provider to be credentialed until the credentialing process is complete. This includes many private insurers, as well as government payers like Medicare, Medicaid and workers' compensation. In most instances, these payers will backdate the effectiveness of the credentialing approval to reflect the date the radiologist began providing services through the practice. Because of this delay, many radiology practices begin the credentialing process upon the physician's acceptance of an offer. This allows several weeks for the administrative work to be completed before claims are submitted.
Other payers may only require a practice identification on the claim (usually the corporation's tax identification number). If this is the case, the practice may bill for the new radiologist's services immediately. | |
