Wiki Supervising MD got paid?

[Blackhorse]

I just join a new pain management practice where I came across a professional claim billed for 62323 with POS 24. On the HCFA form, it's the senior Dr. A's NPI and name, but the documentation is written by junior Dr. B and signed by him also. The claim is denied by Blue Cross because of missing Auth. In order to process retro Auth. AIM needs clinical note and claim#. Dr. A says he's supervising Dr. B, that's why his name and NPI is on the claim form; Dr. B did procedure and that's why he has to document the procedure. I have never heard of this kind of billing method. To my knowledge, whoever does the procedure should be on the claim form as a rendering doctor and needs to document the procedure also. Am I right?

 

[thomas7331]

You are correct, the physician who performed the procedure is the one who should be reported on the claim as the performing provider in box 24J. (Another physician's name could possibly appear on the claim form in box 31 if they are the owner of the practice though.) Physicians cannot bill for services of other providers that they supervise, except in the case of 'incident to' billing when all of the other requirements are met - but supervising alone is not sufficient to meet this requirement.

 

[Blackhorse]

You are correct, the physician who performed the procedure is the one who should be reported on the claim as the performing provider in box 24J. (Another physician's name could possibly appear on the claim form in box 31 if they are the owner of the practice though.) Physicians cannot bill for services of other providers that they supervise, except in the case of 'incident to' billing when all of the other requirements are met - but supervising alone is not sufficient to meet this requirement.

Thank you.