Author Topic: Billing two charges same day different sites.  (Read 815 times)

JVentura1

  • Newbie
  • *
  • Posts: 5
Billing two charges same day different sites.
« on: June 18, 2015, 06:44:57 PM »
Hello:

I am on the fence about this.  It is possible to bill an E/M visit on one NPI and send the patient to a different site for just a CT under a different NPI.  Same EIN. same provider, same day.  Non Facility.  Not free standing Radiology Site.   :-\

Jackie

RichardP

  • Hero Member
  • *****
  • Posts: 688
Re: Billing two charges same day different sites.
« Reply #1 on: June 19, 2015, 04:02:29 PM »
At Location 1:

1. Who is the billing entity?
2. Who is the rendering provider?  (Who did the work?)

At Location 2:

3. Who is the billing entity?
4. Who is the rendering provider?  (Who did the work?)

The puzzle in your question is the EIN.  You state/imply that the EIN is the same for both locations.  Yet you state that the NPI changes from one location to the other while the EIN stays constant.  That is allowable if the billing entity is an organization.  It is not allowable so far as I know if the billing entity is a person, except in the following circumstance:

5.  At Location 1, the work was performed by someone in the employ of the billing entity.  In this situation, employer's Type 2 NPI goes in Box 33a (who gets paid) and the employee's (rendering provider's) Type 1 NPI goes in Box 24J (who did the work).

6a.  At Location 2, the work was performed by a different someone in the employ of the billing entity.  In this situation, employer's Type 2 NPI goes in Box 33a (who gets paid) and the different employee's (rendering provider's) Type 1 NPI goes in Box 24J (who did the work).  OR:

6b.  At Location 2, the work was performed by the billing entity / employer.  In this situation, the employer's Type 2 NPI goes in Box 33a (who gets paid) and his Type 1 NPI goes in Box 24J (who did the work.

Notice in both Points 5 and 6 that the NPI Number in Box 33a stays the same.  It does not change.  The only change of NPI Number happens in Box 24J, which indicates who did the work.  That number should change when the person who actually does the work changes.  And that will happen when an employer/provider owns and works out of several different locations, with different employees at each site.