Author Topic: Need credentialing info for md joining chiropractic office  (Read 1773 times)


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Need credentialing info for md joining chiropractic office
« on: March 14, 2008, 08:26:25 AM »
Hi Michele,
Love your newsletter! A few ?'s I was hoping you might be able to help me with. 1. The Chiro office I work for has recently brought an M.D. on staff 1 day per week. We are doing some billing under him & have filled out the paperwork to have him added to our Medicare and BCBS #'s. He's also listed under our group NPI #, but haven't added him as a provider with the insurance companies we are not contracted with such as Cigna, Aetna and Humana. I have no experience with contracting/credentialing & am not sure what measures to take to ensure any claims billed under him won't be denied. Would we need to notify them or go through some sort of credentialing process? Any advice you could give me would be great.
2. The M.D's title here is the "medical director" and he is prescribing physical therapy, which is being carried out by our PT assistants and is then billed under his name. Does this pose any issues when billing Medicare Part B, especially since he's only here one day per week?
3. We are now doing NCV testing, which is also being billed under the M.D., however he doesn't always see the patient's prior to the test being administered and we often end up waiting for him to sign the prescriptions. In addition we can't send the prescriptions or test results with our claims, since Medicare B only takes electronic claims. Can you suggest any preventative measures we need to take to ensure our claims are processed properly or avoid delays due to the results and/or orders not being included with the claims?
Thank you so much!

Hi Randi,
Iím glad you find our newsletter helpful. That is exactly why we write it!
In answer to your first part of your question, if the MD is par with the other insurance companies (that you are not par with) then are you going to bill under his name & tax ID#? If so, then you will need to contact those companies to make sure he has your practice address listed on their files. If he doesnít want billing done thru his own tax ID (which he may not want since it could be a tax nightmare) then you will be billing all services under your facility name & tax ID number with his name as the rendering physician. If you do not intend to become par with any of the other companies then you probably don't need to do anything to notify them. If you did intend to become par with the companies, then you would just need to contact each one individually and ask them for the paperwork to become an in network provider. Fill it out for your facility, listing both the DC & the MD as providers in the facility.
Iím looking into the second and third questions. Iíll get back to you tomorrow.
Hi Randi,
I wanted to be sure we answered you correctly.
Question 2: Laws vary from state to state, but in NY state (I checked in with my PT specialist) a PT assistant must be supervised by a PT. An MD cannot supervise a PTA. Also, I was told that the PT had to be on the premises while the PTA was with the patient. They also stated that Medicare has a rule that states that to PTA must be in the ďline of sightĒ of the PT when working with a Medicare patient.
Question 3: Iím assuming that NCV testing is nerve conduction velocity. Again laws vary from state to state, but I was advised that NCV testing must be ordered by an MD, so if the MD is not seeing the patient prior to the testing then Medicare (if not other insurance carriers) would probably have an issue with that.
It's probably not good news for you, but I hope that is helpful.

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