This is an actual situation I have just been confronted with. It is not a question from a Billing Exam.
All doctors are on the same floor in the same building, but in different offices. This is not a doctor's group as defined by Medicare.
1. Dr. A employs Dr B.
2. Dr. A has no space for Dr B, so he strikes an arrangement with Dr. C.
3. Dr. C will allow Dr. B to use his space 2 days per week. Dr. C will be absent from that space for those 2 days.
4. Dr. A will allow Dr. C to bill for the
labs and x-rays ordered by Dr. B. Dr. C can keep the money as payment for allowing Dr. B to use his office space. (Office visits and other non-lab work and x-ray work will be billed by Dr. A)
5. Consider: proper Medicare billing requires the CMS Form 1500 / Electronic Billing to show the NPI numbers for "who gets paid" and "who did the work".
6. Consider: Stark laws prohibited certain kinds of behavior having to do with kickbacks
Question:Dr. B decides what lab work needs to be done and what x-rays are needed. Labs and X-rays are done in-house in a POL that is "owned" by about 12 individual doctors, including Drs. A and C (not a legit setup, based on the definition of a POL, but not part of this question)
They want us to bill for these labs and x-rays using Dr C as both "who gets paid" and "who did the work".
Problem is, Dr. C is nowhere around. He is the one getting paid, per agreement with Dr. A. But Dr. C did not see the patient and he is not the one who ordered the labs and x-rays. That was done by Dr. B, who is not an employee of Dr. C, the one getting paid.
I'm thinking that it is not legit to present Dr. C as both "who gets paid" and "who did the work" on Dr C's CMS Form 1500 / Electronic Billing.
I'm thinking that it is also not legit to present Dr. B as "who did the work" on Dr C's CMS Form 1500 / Electronic Billing, because he is not employed by Dr. C.
Q1: What sort of problem do you see coming up if we bill Dr. B's work under both of Dr. C's NPI numbers for "who gets paid" and "who did the work" under this scenario?
Q2: Is it legal to put Dr. B's NPI # on Dr. C's billing as the one who did the work, even though he is not employed by Dr. C?
I will understand if your response is "ask a healthcare attorney".