Author Topic: BCBS billing- individual vs.group  (Read 1671 times)

PTinFL

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BCBS billing- individual vs.group
« on: November 10, 2015, 02:15:06 PM »
I am working at a Physical therapy clinic, private practice owned by Physical therapist. Can any one give me advice or point in the right direction of where to go. Currently the owner is having our in-house biller bill all services provided to BCBS pt's under the owner's/PT's individual provider #. However Myself and other therapists are rendering the services. This PT/owner has applied for organizational provider # however has been denied, she feels that being able to treat patients in our community is the most important even if it requires removing rendering therapists names. Correct me I'm wrong, but this is wrong, correct???



rdmoore2003

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Re: BCBS billing- individual vs.group
« Reply #1 on: November 10, 2015, 04:49:31 PM »
Do you know why she was denied for group NPI?  You have to list the rendering provider/rendering NPI when licensed.
Regina

kristin

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Re: BCBS billing- individual vs.group
« Reply #2 on: November 10, 2015, 08:48:28 PM »
You are correct, this is wrong. The rendering provider should be listed as such on the claim, when applicable. By not doing so, this could/would be considered fraudulent billing. While I understand the desire to treat patients is important, what the PT who owns the practice needs to understand is that it in order to be paid for that treatment by insurance, it has to be done legally.

One thing to be considered is that if the owner is billing everything under their name as rendering, an insurance company such as BCBS will eventually realize that the amount/time of services being billed in one day for "one" provider is more than they could actually do. I have seen this happen before, with a provider who was doing the same thing as you describe. Eventually they were audited, and had to pay back quite a bit of money.

PMRNC

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Re: BCBS billing- individual vs.group
« Reply #3 on: November 11, 2015, 06:23:43 AM »
I agree with the others, this not only has to be corrected but monies have to be returned before you get into a red flag/audit situation.

Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
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PTinFL

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Re: BCBS billing- individual vs.group
« Reply #4 on: November 16, 2015, 06:59:21 PM »
Thank you for your input, I appreciate it. I know this is wrong and fraudulent. Once I found out this was going on I put in my 2 weeks. I know this is unethical! The fact she feels its ok is unbelievable. I have done what I needed to do, pretty sure BCBS is investigating this one! : )

PMRNC

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Re: BCBS billing- individual vs.group
« Reply #5 on: November 17, 2015, 08:44:55 AM »
Quote
Thank you for your input, I appreciate it. I know this is wrong and fraudulent. Once I found out this was going on I put in my 2 weeks. I know this is unethical! The fact she feels its ok is unbelievable. I have done what I needed to do, pretty sure BCBS is investigating this one! : )



Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com