andersona1229
Contributor
I work for an independent laboratory that has an ordering provider who straddles a state line. We're getting a bit of pushback regarding what would decide the local plan from the ordering provider because their NPI is registered in one state but the specimens are being ordered and obtained in the neighboring state. We're trying to find something that will better explain what constitutes the local plan. Everything we're finding isn't exactly clear as it states where the "referring/ordering provider is located" which could mean either where they're practicing out of or, it could be argued, where the NPI is registered to. We have confirmed that it isn't overlapping service areas. As far as our billing practices for this go, we would be billing the local plan for where the specimen was obtained regardless of where their NPI is registered.
Question is, will their NPI being registered in another state impact who the local plan is and where can we find documentation for that to assuage their concerns?
Question is, will their NPI being registered in another state impact who the local plan is and where can we find documentation for that to assuage their concerns?