Hello,
I have an issue here at my Physical Therapy office where we saw an HMO patient when we should not have because we did not participate. My Orthopaedic Surgeons did not see this patient as he was an outside physician referral. The previous staff billed this under my PT and the claims were denied as non authorized which was correct since we were not participating. They now want to put my doctors name on the claim and resubmit a corrected claim. Can anyone help me find documentation to show them that in billing this "corrected" claim, we are committing fraud? Since this patient was and is not under the care of our doctors, we can't knowingly bill this with their name on it, can we?? HELP!!!
I have an issue here at my Physical Therapy office where we saw an HMO patient when we should not have because we did not participate. My Orthopaedic Surgeons did not see this patient as he was an outside physician referral. The previous staff billed this under my PT and the claims were denied as non authorized which was correct since we were not participating. They now want to put my doctors name on the claim and resubmit a corrected claim. Can anyone help me find documentation to show them that in billing this "corrected" claim, we are committing fraud? Since this patient was and is not under the care of our doctors, we can't knowingly bill this with their name on it, can we?? HELP!!!