Author Topic: Billing for a Supervising Physician  (Read 5575 times)

Sportsmom

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Billing for a Supervising Physician
« on: February 27, 2011, 07:01:05 PM »
 I'm billing for a mental health office, I just would like to make sure I'm billing for the Supervising Physician right.

The office has a LPC that sees Medicare clients since Medicare does not pay for LPC to see clients they have a Psychiatrist that over see him.
When I bill Medicare for the LPC I have the Psychiatrist name in box 31 for Supervising Physician, then in box 24 J I have the Supervising Physician Medicare number and the NPI is the Supervising Physician.
Is this the right way to bill for LPC? Thank you all for your help.


Michele

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Re: Billing for a Supervising Physician
« Reply #1 on: February 28, 2011, 10:53:24 AM »
Sounds like you've got it right!
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rdmoore2003

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Re: Billing for a Supervising Physician
« Reply #2 on: February 28, 2011, 11:59:36 AM »
yes this is right.   I have LPC's that are supervised by Medical Psychologist.  You are doing it correctly.
Regina

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Re: Billing for a Supervising Physician
« Reply #3 on: February 28, 2011, 05:51:47 PM »
That is correct..let me just add something from experience with two providers I billed for ..same situation..both were supposed to be supervising. Make sure you look up the rules/regs on supervision..I found out mine were NOT on grounds at time of visit and that was one of the requirements. I didn't discover it until one day I got superbills from the provider with the LPC's signature and I knew the PHD (supervising provider) was away for 2 weeks! Turns out that it had been going on a LOT, but once I discovered it I had to stop billing for him since it would be considered fraud on my part as well as their's. I did end up getting a whistleblower's payment 3 years later :)  The other one I couldn't prove it but terminated him as soon as I suspected it. KNOW your supervision rules and be aware!
Linda Walker
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Sportsmom

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Re: Billing for a Supervising Physician
« Reply #4 on: February 28, 2011, 08:04:01 PM »
Thank you all so much. I thought I had it right but always better to double check to make sure.


Michele

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Re: Billing for a Supervising Physician
« Reply #5 on: March 01, 2011, 07:06:58 AM »
Good point Linda!
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rdmoore2003

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Re: Billing for a Supervising Physician
« Reply #6 on: March 01, 2011, 03:35:25 PM »
yes,,,thank you....  as a rule for medicare, if the M.P. is not within 15 minutes away,,, we will not see medicare client.    He is always here in the office so we have no issues.    good example: tomorrow he has been subpeoned to court which is over 2 hours away from office.   we have cx appts for most pts with medicare, the few that are remaining is being seen at no charge (only due to emergency situations)
Regina

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Re: Billing for a Supervising Physician
« Reply #7 on: March 02, 2011, 01:44:22 PM »
Quote
yes,,,thank you....  as a rule for medicare, if the M.P. is not within 15 minutes away,,, we will not see medicare client.    He is always here in the office so we have no issues.    good example: tomorrow he has been subpeoned to court which is over 2 hours away from office.   we have cx appts for most pts with medicare, the few that are remaining is being seen at no charge (only due to emergency situations)

I didn't mean to imply all providers would do what mine did. I was making it a point that it COULD happen and you wouldn't know about it. It was just dumb bad luck that my client told me about his fishing trip and the LPC faxed over his daysheets on a day I knew the PHD was NOT even in state!  He tried to tell me he didn't know, but really that was a moot point in my opinion because fraud/abuse regs have NO tolerance or wiggle room for "ignorance"
Linda Walker
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aknittel914

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Re: Billing for a Supervising Physician
« Reply #8 on: November 02, 2014, 03:20:20 PM »
That is correct..let me just add something from experience with two providers I billed for ..same situation..both were supposed to be supervising. Make sure you look up the rules/regs on supervision..I found out mine were NOT on grounds at time of visit and that was one of the requirements. I didn't discover it until one day I got superbills from the provider with the LPC's signature and I knew the PHD (supervising provider) was away for 2 weeks! Turns out that it had been going on a LOT, but once I discovered it I had to stop billing for him since it would be considered fraud on my part as well as their's. I did end up getting a whistleblower's payment 3 years later :)  The other one I couldn't prove it but terminated him as soon as I suspected it. KNOW your supervision rules and be aware!

I was looking for information on supervising physicians and I came across this old post. Can you give me any advise as to how to find supervision rules/reg for the State of Florida. I am googling and googling and can't seem to find what I need. Thanks!

kristin

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Re: Billing for a Supervising Physician
« Reply #9 on: November 02, 2014, 04:33:10 PM »
I Googled "Florida regulations+supervising physician", and got this hit, as relates to PA's in Florida:

http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0458/Sections/0458.347.html

See section F:

(f) “Supervision” means responsible supervision and control. Except in cases of emergency, supervision requires the easy availability or physical presence of the licensed physician for consultation and direction of the actions of the physician assistant. For the purposes of this definition, the term “easy availability” includes the ability to communicate by way of telecommunication. The boards shall establish rules as to what constitutes responsible supervision of the physician assistant.


Because it mentions telecommunications, it would seem the SP does not need to be in the same location as the PA when the PA is seeing patients.
« Last Edit: November 02, 2014, 04:34:49 PM by kristin »

aknittel914

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Re: Billing for a Supervising Physician
« Reply #10 on: November 02, 2014, 05:28:16 PM »
Because it mentions telecommunications, it would seem the SP does not need to be in the same location as the PA when the PA is seeing patients.

Thank you!

That being said, lets say Florida says the SP does not need to be in the same location. Ultimately, if the payer rules that the SP DOES need to be in the same location, that is the rule I need to follow. Correct?

On a similar note, this potential client has asked "you know how to bill out-of-network, right"... Well yes I do... and he says "because we want to make sure we bill out-of-network whenever we can, we have some providers that are credentialed and some that are not" I take this as he is implying that I bill the service under whichever provider will get paid the best... In this situation would any of you say run as fast as I can, or should I try to do some more digging. Perhaps the client is ignorant in the fact that you can only bill incident to if specific qualifications are met. If I correct his ignorance before I start billing am I safe, or do I just run :) Thanks for any advise!!

kristin

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Re: Billing for a Supervising Physician
« Reply #11 on: November 02, 2014, 05:41:06 PM »
I think state law trumps the payer, but am not positive about that. Someone else may know that answer to that. I swear I saw a mention of this with Medicare, where they mentioned state laws being what to follow, but I can't find it now. If I do, I will post it.

As for what you are being told by the potential client, at face value, it does seem like they are telling you to do something fraudulent. Whether that is because they are ignorant of how to bill, or are straight-up trying to be fraudulent is another matter. You may want to clarify exactly what it is they are trying to tell you, and if it NOT due to ignorance, run for the hills.

PMRNC

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Re: Billing for a Supervising Physician
« Reply #12 on: November 03, 2014, 01:00:16 PM »
Whichever is stricter is actually the trump/superceder.   So if state law says they have to be there on spot, Medicare says certain availability" you would follow state.
Linda Walker
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aknittel914

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Re: Billing for a Supervising Physician
« Reply #13 on: November 06, 2014, 10:18:42 AM »
Thanks for the clarification!