Wiki Billing for the non-contracted provider

[prabha]

Any input on this would be of great help!!!!

In a office setting, the contracted provider does 50% of the services and its billed using his ID.

There is also a non-contracted provider who does the other 50% of services. His claims are also billed under the contracted provider's ID since they belong to the same group.

Is this correct or what's the other way to bill for the non-contracted provider?

 

[thomas7331]

I'm surprised that a question such as this is still asked these days. Billing one provider's services under a different provider's name and credentials (except in the very limited situation of an 'incident to' service) is, quite simply, a false claim. If this is being done knowingly and intentionally for the purposes of obtaining a more favorable payment than the practice would be entitled to by billing correctly, it could very likely be considered fraudulent billing and could expose the practice to pretty severe financial and possibly even criminal sanctions. If you have any doubts about the accuracy of your claims, you should refer this to a compliance specialist who can do a thorough review and recommend the appropriate remedies that are needed, if any, to bring your practice into compliance.

 

[OpenClaims]

No, this would not be correct. Because the other provider is non-contracted, this most likely will result in a denial. In addition, if this is continuously done, it may kickback as fraudulent claim activity on your end.