Medical Billing Forum
Billing => Billing => : Oscar12 February 25, 2015, 01:25:26 PM
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Another doctor (not one I bill for) has been telling my doctor that if you perform a group of services on one day that is more than the usual and customary that would be reimbursed for one day, it is ok to bill them with 3 dates of service so that they will be covered. For example, doctor performs 20 xyz tests on 1/1/15, but knows insurance will pay for only 8 per day. Doctor then bills 8 xyz tests for 1/1/15, 8 for 1/2/15, and 4 for 1/3/15. I am pretty sure that this is NOT ok, but I would like confirmation.
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You are right, that is not okay. The date of service has to be the date the service(s) was performed...you can't try to get around maximum units for a service payable on one date by billing them on dates they weren't performed.
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Thanks for the confirmation.
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More specifically, by signing Box 31 on the CMS 1500 Form, you are certifying that the page accurately reflects what happened on that Date of Serice. When you signs at Box 31 when the form does not accurately reflect what happened, you commit fraud - for which you can be found out and prosecuted.
How can you be found out? The patient will get an Explanation of Benefits (or Payment) that tells them they saw you on days they know they did not see you. All the patient has to do is call their insurance carrier, confused about the EOB, for the carrier to be alerted to your fraud.