Author Topic: Is it Ethical to bill under someone else's NPI while being credentialed  (Read 1329 times)


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Hello Forum,
I am still plagued with this billing question.
I bill for a very large group practice, LLC. New clinicians are constantly being added to the group. Right away admin personnel start the process of credentialing of insurances however the new clinician starts seeing  patients. The Doctor (owner of the group that has a PhD) supervises the clinician. Claims are currently billed as follows: Group TAX, Group NPI with rendering provider the owner of the group NOT and new clinician. When credentialing in complete the switch in rendering NPI is made.

Is there anywhere on the electronic HCFA I can enter that the clinician is being supervised under the owner and use the clinician NPI until they are credentialed.
I just want to make sure we are on the up and up.


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Re: Is it Ethical to bill under someone else's NPI while being credentialed
« Reply #1 on: September 11, 2016, 04:41:31 PM »
This is a problem that plagues all offices that are adding new providers.   You did not mention what the credentials of the clinician are, but I know for doctors they must bill the rendering out as the provider who performed the service.   We are going through this right now.  We have a provider who just finished her internship and received her license.  One of our groups hired her and we are working on the credentialing.  Until she is credentialed she cannot see patients with that insurance, or it will be processed as out of network.  With Medicare we can hold the billing until the app is complete since they backdate.
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