provider has 2 locations: can he bill under main location?

[thelakeshow2k]

hi,
my provider has a main office and a satellite office (goes there once a week).  can he submit claims (patients seen at the satellite office) using the main office as service facility location (box 32 cms1500)?  is that a common practice for providers bill that way?  are there any legal issues to be aware of?   

the provider feels it would be simplified and more streamlined to enroll with insurance carriers listing only one location. 
   

[Michele]

Actually both locations need to be on file with all insurance carriers, and the location that services were rendered in would go in Box 32.  All payments can be made to the main location.

Michele

[thelakeshow2k]

what would you say to a provider that says that other providers do it and it keeps things streamlined?

[Michele]

I would say it is illegal to report that services were performed in a location other than where they were performed.  It really doesn't "streamline" anything, that is just a way to say "I don't feel like doing the necessary paperwork to make sure the claims are being billed properly". 

Sorry, that's probably a little harsh, but it's true.  I've seen many providers like this.  But you can also say, if he/she gets audited, the insurance carriers could determine that they broke their contract with them by not reporting the satellite office and billing as if services were done in the main office and terminate them.

Just to have some backup you could call a local provider rep for any insurance carrier and ask them if it is ok to bill satellite office as main office.

Good luck,
Michele

[PMRNC]

what would you say to a provider that says that other providers do it and it keeps things streamlined?

I'd ask him if all the other doctors jumped off a bridge would he?