Poll

If one doctor sees a pt can you bill using another drs npi that is within the same practice?

Yes
0 (0%)
No
3 (100%)

Total Members Voted: 3

Author Topic: Billing under a different NPI  (Read 4450 times)

mrsmeck

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Billing under a different NPI
« on: May 17, 2012, 08:04:00 AM »
We have a doctor that is not in network with a specific carrier, but our other doctors are.  Can we bill out with another doctors NPI that is within the same group and will be paid to the same group npi?

I feel the answer is no, but before I draw a hardline on this with the management I was to have all my ducks in a row...

Thanks!

Michele

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Re: Billing under a different NPI
« Reply #1 on: May 17, 2012, 10:12:34 AM »
You can't use a different drs npi for that dr because he is out of network.  The rendering dr's npi must be the one on the claim.
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rdmoore2003

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Re: Billing under a different NPI
« Reply #2 on: May 17, 2012, 04:07:43 PM »
not under this
Regina

billingandscanning

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Re: Billing under a different NPI
« Reply #3 on: June 04, 2012, 05:34:25 AM »
Michele is correct. If the insurance company came in and did an audit, the medical record and the claim need to match, example the doctor who saw the patient is the same doctor that billed for the service.

DMK

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Re: Billing under a different NPI
« Reply #4 on: June 04, 2012, 10:19:05 AM »
What if there are two doctors sharing the front door, one doctor is out sick and the other doctor sees the sick doctors patient?  Or a Locum comes in for vacation coverage?

Michele

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Re: Billing under a different NPI
« Reply #5 on: June 05, 2012, 06:00:14 AM »
It would have to be billed under the provider that physically saw the patient.
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Pick3dlast

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Re: Billing under a different NPI
« Reply #6 on: June 11, 2012, 05:34:42 PM »
So in the most recent example you gave, if a Locum saw the patient than it would strictly be under his name and NPI with groups TIN & the modifier indicating locum tenan. If a patient was seen by a provider that was part of a contracted group all he would have to do is get credentialed to see patients. Contracts are group specific only. If the group was contracted and he was not credentialed then your claim will deny for non-contracted. unless you had a letter of agreement on file through that particular Health plan (very rare because they are patient specific) The renderings NPI must always be the one in box 24J of a CMS, the only exception to this is a mid-level can be paid under the resident or practice owner (if physician).