Author Topic: Phlebotomist for private practice  (Read 1356 times)

ttenaglia

  • Newbie
  • *
  • Posts: 7
Phlebotomist for private practice
« on: May 22, 2015, 12:50:53 PM »
I have a client who wants to add a phlebotomist to their practice for venipuncture services.  This is for a private practice.  Is the rendering provider the physician ordering the service?  Is the phlebotomist referenced anywhere on the claim?

Thanks in advance.

RichardP

  • Hero Member
  • *****
  • Posts: 688
Re: Phlebotomist for private practice
« Reply #1 on: May 23, 2015, 11:09:30 AM »
Who is the billing entity?  The answer to that question determines the answer to your question.

I assume that your client will hire the phlebotomist and pay him.  If that is the case, the phlebotomist's NPI Number (if he has one) would go in Block 24J of the CMS 1500 Form if the insurance carrier requires that.  We are in California and none of the commercial carriers we deal with require this.  But Medicare does.  If the phlebotomist does not have an NPI Number, then your client's NPI Number would go in Block 24J, at least for Medicare claims, but also for any other commercial carrier in your state that requires an NPI Number in this field.

Consider the nurse in your client's office who may give flu shots under the supervision of your client.  The nurse does not have an NPI Number - so the only information on the CMS 1500 Form (or electronic billing data) is your client's information.  The payor never knows it was not your client who gave the flu shot.  See my response at this link for a bit more detail on this if you are interested.

http://www.medicalbillinglive.com/members/index.php?topic=7045.msg21031#msg21031



ttenaglia

  • Newbie
  • *
  • Posts: 7
Re: Phlebotomist for private practice
« Reply #2 on: May 23, 2015, 01:52:40 PM »
Thanks Richard.  That does help.  And yes, client hiring and paying him/her.

Two follow-on questions:

1) Is there an easy way to determine if a payor requires it?  Or is it a matter of just calling and asking?

2) Is it valid to submit the phlebotomist's NPI to the commercial payors even if they don't require it in 24J, or will it need to be the client's?

Thanks,

Tom

RichardP

  • Hero Member
  • *****
  • Posts: 688
Re: Phlebotomist for private practice
« Reply #3 on: May 24, 2015, 11:10:16 AM »
The NPI Number for who does the work goes in Box 24J on the CMS 1500 Form - if it is required.  The NPI Number for who gets paid goes in Box 33a - always.

Your Q2:  The NPI Number in Box 24J needs to be the number of who did the work.  If the phlebotomist does the work, and if s/he has an NPI Number, the phlebotomist's NPI Number goes here.  For the California commercial carriers, it makes no difference if the number is there or not.  I cannot speak for the carriers in your state.  (We can put the number there, even though it is not required, and the claim still gets paid properly.)

Your Q1:  Call and ask.  Or submit without the NPI Number in Box 24J and see if the claim gets paid.  Or Google for medical billers in your state and call and ask them.

ttenaglia

  • Newbie
  • *
  • Posts: 7
Re: Phlebotomist for private practice
« Reply #4 on: May 25, 2015, 12:27:26 AM »
Thanks so much!!