IDTF Billing

[asilva03]

I have an IDTF that created a sub-company because they were told that many insurance carriers do not recognize IDTFs or know what they are, only Medicare does.  They want to submit billing for their contracted radiologists under the radiologists' NPI, but receive payment under the sub-company name.  They also want to use the IDTF for Medicare purposes only and use the sub-company for all other carriers since they do not recognize IDTFs.  Has anyone ever heard of this?

[RichardP]

Short answer:  Yes.

In order for the sub-company to receive payment, it must be the billing entity.  In order for it to be the billing entity, it must have a Type 2 NPI Number (who gets paid).  The Radiologists must each have their own Type 1 NPI Number (who did the work).

When you submit the billing, the Type 1 NPI Number for the Radiologist who did the work goes in Box 24J on the CMS 1500 Form.  The Type 2 NPI Number for who gets paid goes in Box 33a.

If sub-company is not set up as a legitimate billing entity, with its own Type 2 NPI Number, it cannot receive payment.

That is the way it works for Medicare.  Many carriers follow the Medicare model, so the restrictions set out above would be true for them.  But you won't know for certain until you find out, by either submitting a billing, or calling them and asking.

If you are going to test by billing, place no NPI Number in Box 24J, and place the address you want payment mailed to in Box 33.  The stickler will be that the Carrier will probably want to see a Type 2 NPI Number in Box 33a.  Whose NPI Number will you place there if the sub-company does not have one?  If the Carrier runs a match on the Type 2 NPI Number in Box 33a and the Name in Box 33, and they don't find a match, you could have a problem bigger than just getting the payment denied.  You could be charged with fraud.

This would be a good situation to run a quick question past a Health Care Attorney knowledgeable about health insurance regulations for your State.

[asilva03]

Thanks Richard.

So, if they wanted to bill to Medicare could they bill under the IDTF and if they wanted to bill to commercial carriers could they bill under the sub-company as long as it has a Type 2 NPI? 

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