Author Topic: Rendering Provider  (Read 1591 times)

JeannieAllen

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Rendering Provider
« on: September 01, 2011, 09:06:21 AM »
Good morning, I have a question regarding block 24 J of the CMS 1500 form. I have recently taken over the billing for an office that puts the business owner in that block and not the provider that actually cared for the patient. In fact, the provider that cared for the patient is not listed at all on the CMS form. It is my understanding that 24 J must list the provider that performed the services on the patient, is this correct? I am guessing that the reason they are not listing the provider who performed the services is because thay have not set her up to take the insurances under the owners tax id. If I am correct with this assumption do I have to set up the provider to take the insurances under the owners tax id before I can put her NPI in block 24 J? And in the mean time can I use modifyer Q5 (substitute provider) with the rendering providers NPI in block 19 and the owners NPI in block 24 J? Thanks, Jeannie

Michele

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Re: Rendering Provider
« Reply #1 on: September 02, 2011, 07:11:01 AM »
You are correct.  The rendering provider NPI (box 24J) should be the actual provider who treated the patient, unless the person treating the patient is being supervised and the supervising provider's NPI would be there.  If they are doing it just because they haven't properly credentialed the provider the Q5 would not be appropriate.  Please see this link:

http://www.cgsmedicare.com/partb/pubs/news/2008/0108/cope7038.pdf

Each insurance carrier needs to be contacted to find out what needs to be done to get the rendering provider set up under the group. 
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