Author Topic: HELP! BILLING UNCREDENTIALED NP (Read 2992 times)

bosox85 · « **on:** November 18, 2019, 12:30:04 PM »

A provider (NP) started at my practice (which consists of ALL NPs) on August 4 and I was told to bill for her under another NP's NPI. Being fairly new to Medical billing, I did as I was told. I have been doing a lot of research, and believe how I was told to bill is VERY wrong. This provider is STILL not credentialed or contracted. I have been holding the charges for this NP all month. Am I correct that this practice is wrong and could have some serious ramifications? I am a department of 1 and need to speak for myself, but want to make sure I am correct in my thinking.

I thank you very much for reading this far and appreciate any responses.

Michele · « **Reply #1 on:** November 18, 2019, 05:01:43 PM »

You are not supposed to bill for one providers services under another providers NPI unless it is a supervising situation. It cannot be done simply to get the services paid for. It sounds like that is why it is being done in this case, since the NP is not credentialed yet. When a new provider is added to a group the billing should not be submitted until the credentialing is completed.

bosox85 · « **Reply #2 on:** November 18, 2019, 11:27:27 PM »

Thank you so much for your response. This is exactly what I suspected. I think I may be looking for a new place of employment.

Michele · « **Reply #3 on:** November 19, 2019, 12:08:00 PM »

Sorry that you find yourself in this position, but it's a smart decision. The biller is just as responsible.

PMRNC · « **Reply #4 on:** November 19, 2019, 12:41:55 PM »

I would add that you shouldn't send any more claims since you know them to be false claims from this moment on. Even if you were to give notice today, it won't protect you from any claims you filed when you learned of the problem.

Medical Billing Forum · « **Reply #4 on:** November 19, 2019, 12:41:55 PM »

bosox85 · « **Reply #5 on:** November 19, 2019, 04:12:04 PM »

Thank you! I have been holding her charges since November 1, so they are really building up. My gut has been telling me for a while now that this is NOT OK. I wish I listened to my gut sooner.

Any suggestions on how to approach this subject with administration?

Michele · « **Reply #6 on:** November 19, 2019, 05:18:39 PM »

Well maybe they are just unaware that it's not ok. I would start by saying that you've looked into it and that you found it that it's not ok to bill for one provider services under another provider NPI and you're not comfortable billing them out that way. See where it goes from there.

bosox85 · « **Reply #7 on:** November 19, 2019, 05:35:29 PM »

Thank you! I really appreciate everything!

kristin · « **Reply #8 on:** November 20, 2019, 01:13:02 AM »

Just to add...everything you have been told here is dead on...you can't bill for one NP under another NP's NPI as rendering provider. While the NP's who run the office, or whoever runs the office may not have known this, it doesn't change the reality of the situation. Credentialing/contracting of a provider can take a LONG time, and the retroactive date is usually not much, so that provider could have numerous claims that will never get paid.

bosox85 · « **Reply #9 on:** December 01, 2019, 07:41:15 PM »

I am now being told by the CEO of our health care group that because the group's NPI is submitted on the claim and not the rendering NP's NPI number, then we can bill it. I still say I'm not doing this because it is wrong. Who is correct? The CEO or me?

Thanks~M

Medical Billing Forum · « **Reply #9 on:** December 01, 2019, 07:41:15 PM »

Michele · « **Reply #10 on:** December 02, 2019, 10:10:07 AM »

The group's NPI may be on the claim in box 33a (and 32a) but the question is whose NPI is in box 24J? 24J is the rendering provider's NPI. That cannot be a group NPI, it must be the individual NPI of the person who rendered the service. There are a very few scenarios where 24J can be a group NPI. We bill for a portable x-ray company. Since they are an x-ray provider and are billing for technical services, the group NPI goes in 24J because the company is rendering the services. So I can't say that a group NPI NEVER goes in 24J but billing for NP services, an individual NPI would be in box 24J. So there is an individual NPI on the claim for the NPs services. Whose individual NPI is that? And the name of that provider goes in box 31. Whose name is in box 31? The answer should be the NP who saw the patient.

Michele · « **Reply #11 on:** December 02, 2019, 10:13:28 AM »

Unless like I mentioned earlier, the NP is still in training and being supervised. Then the supervision rules would apply. https://www.aafp.org/fpm/1998/0500/p12.html

bosox85 · « **Reply #12 on:** December 02, 2019, 11:31:14 AM »

Thanks, Michele.

You have some great information. I think I'm going to stand my ground and let them show me documentation of why they feel they can bill this way.

I appreciate all your help!

kristin · « **Reply #13 on:** December 02, 2019, 11:26:15 PM »

Definitely stand your ground! What is baffling to me (and disturbing for that matter) is that it is the CEO telling you that it is okay. As Michele mentioned, there are very few instances when this is allowed. Yes, the NP rendering the services could be being supervised by the NP whose name is going in 24J, but it sounds like that is not the case here. It sounds like the health care group hired an NP who was not credentialed/contracted (their bad), and decided to do a "run around" until the NP is credentialed/contracted.

All it takes is for one savvy, persistent patient to get an EOB with the name of the NP they didn't "see" listed on it as the NP they "saw", and call their insurance screaming fraud, and game over.

Medical Billing Forum · « **Reply #13 on:** December 02, 2019, 11:26:15 PM »

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