Author Topic: another PT treating a patient  (Read 2422 times)

Anne

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another PT treating a patient
« on: March 25, 2008, 12:55:16 PM »
If a PT wants to pay another PT to treat a patient for her, how do you indicate that on the claim.  I believe for Medicaid patients you put U1 in as a modifier, what about the primary?  Do you also use U1 for them?  Who's NPI and tax ID do I use?  The first PT has a group NPI and Tax ID.  What is she's an individual provider?

Michele

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Re: another PT treating a patient
« Reply #1 on: March 26, 2008, 11:43:10 AM »
If a PT wants to pay another PT to treat a patient, but still wants the insurance reimbursement to go to him/her, then the PT that would be treating the patient would need to be credentialed by the insurance carriers under the first PT.  Then on the claim, the name of the treating PT would go in box 31, & that PT's individual NPI would go in 24J.  The first PT, who wants to be reimbursed, would put their billing info and Group NPI in boxes 32 & 33.

Thanks
Michele
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Anne

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Re: another PT treating a patient
« Reply #2 on: March 27, 2008, 09:46:54 PM »
What if first PT is out of network? 

Alice Scott

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Re: another PT treating a patient
« Reply #3 on: March 28, 2008, 11:30:41 AM »
If the first PT is out of network, the PT that is paid to cover (if covered under the first PT) would also be considered out of network.
Michele
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Anne

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Re: another PT treating a patient
« Reply #4 on: April 30, 2008, 05:27:31 PM »
what if the first PT - the one to be reimbursed just has an individual ID, not a group ID, can we do the same thing?  thanks, Ryanne

Michele

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Re: another PT treating a patient
« Reply #5 on: April 30, 2008, 10:11:19 PM »
Do you mean individual NPI ID, or Insurance ID?  Bottom line, in either case, the 2nd PT would have to be credentialed under or linked to the first PT by the insurance carrier, whatever ID # the first PT is using.

Michele
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Anne

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Re: another PT treating a patient
« Reply #6 on: April 30, 2008, 10:27:16 PM »
so first PT would have to have a group ID and group NPI in order to have second PT linked, right?  ins. carrier wouldn't link a PT to an individual EIN  - correct?  None of PT's or OT's I'm talking about are credentialed with the ins. carrier - they are seeing these patients out of network with Medicaid as secondary ins.  thanks for your help,  Ryanne

Michele

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Re: another PT treating a patient
« Reply #7 on: May 06, 2008, 10:00:46 AM »
Most carriers would require that the PT have a group EIN & NPI in order to link others to them.

Michele
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jwoman9835

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Re: another PT treating a patient
« Reply #8 on: August 16, 2009, 04:49:54 PM »
How would this work for medicare Part B? If I am the PT provider but hire another PT or PTA to do some treatments do they need their own Med B provider number or do they work under mine?  Do they need their own NPI?

Does my Med B provider number for PT allow me to hire an OT if prescription call for that too?
Jill, PT

PMRNC

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Re: another PT treating a patient
« Reply #9 on: August 16, 2009, 04:59:06 PM »
wouldn't they need to setup a locum tenens?
Linda Walker
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Michele

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Re: another PT treating a patient
« Reply #10 on: August 16, 2009, 07:58:04 PM »
Any other providers that work for you must be credentialed with Medicare and have their own individual NPI.  You would link them to you by completing the CMS 855R form to re-assign the benefits to pay to you.  This would be for an OT or PT.  If it is a PTA, you can bill under your name, NPI, and Medicare PTAN, as long as you follow all guidelines for using a PTA.  (I.E.  Medicare patient must be in sight of PT, etc.)  I'm really not sure on the guidelines, I just know they are there.

Michele
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