Billing > Billing
HELP! BILLING UNCREDENTIALED NP
Michele:
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:
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:
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:
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.
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