Double Co-Payments

[NYMBS]

I have a provider in TX who render services in a hospital clinic for a guaranteed salary.  The clinic is considered on-campus because it's less than 250 yards from the main building.  She bills as place of service 11-office under her own corporate name, corporate tax ID and NPI.  She does not use the hospital's name, tax ID or NPI.  She turn over all her payments to the hospital.

Here's my delema .  Her patients are paying two co-payments; one to the hospital and one to her.  Why would this be? 

Should she use place of service 11-office or 22-outpatient hospital? 

Should she turn over her payments to the hospital since she's billing under her own tax ID?

Thanks in advance for any insight you can offer.

[PMRNC]

Since you said she is turning over all payments, she technically is not in "private practice" but you have to see how she is credentialed and setup, is she setup with carriers as a practice? You might have a big problem if she is not billing properly and accordingly. Also she's looking at another problem if she's billing with her own Tax ID and getting paid by hospital right there is a nightmare.

[Michele]

Also, it may be breaking her contract with the insurance carriers if the patient is being charged two copays.  They can terminate the contracts if that is the case.

Michele

[NYMBS]

Apparently, the CFO of the facility told her to bill this way.  I am waiting for a returned phone call.  I'll keep you posted.  Thanks for your replies.

[PMRNC]

The CFO told her to do that and she actually listened to that? 

So they have her billing, she turns over the payments, they pay her and bill as well ..You got a big big big mess here and I would say to have your client stop everything and consult with an attorney. Also.. now that you are aware of this potential problem (even if it's just a suspicion) you entered yourself as a libel party so do NOT send another charge anywhere. Document all of this and tell the provider she has to get this taken care of. If you bill another charge not knowing the legal structure of this arrangement, you can get in just as much trouble as the doctor and the facility.