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Provider Billing Another Provider

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barb2512:
I do billing for a mental health counselor, LPC in the state of Texas. We'll call her Counselor A.

Counselor A invites another counselor, Counselor B, to use her office space when it is free and will funnel some of her referrals to Counselor B. Counselor A tells me, her biller, that Counselor B will be seeing the clients and the sessions will be billed under Counselor A. Not under the business or the facility, but using Counselor A's name, tax ID and NPI with no mention on the claim that Counselor B actually saw the client.

This is not a supervision situation. Counselor A calls it 'consulting.' She tells me it is okay to bill it that way. I am sure they will discuss the clients and their situations from time to time. But I am not comfortable.

Any thoughts?

Barbara

PMRNC:

--- Quote ---Counselor A invites another counselor, Counselor B, to use her office space when it is free and will funnel some of her referrals to Counselor B. Counselor A tells me, her biller, that Counselor B will be seeing the clients and the sessions will be billed under Counselor A. Not under the business or the facility, but using Counselor A's name, tax ID and NPI with no mention on the claim that Counselor B actually saw the client.

--- End quote ---

Your discomfort is on the money. I would tell her that nicely and then ask if you can have the business structure of this arrangement to run by your attorney <wink>    Another thing bothers me too is when you say Counselor B will get referrals from A, and then A is going to have billing under them.   Right there STARK Flags come up big time.   I probably would flat out just say no, but if you want to tread lightly you should make sure you get a formal statement of their arrangement and run it by your attorney to cover your own *%^

rdmoore2003:
absolutely in agreement with Linda.  OMG, your gut was right, listen to it.

barb2512:
Sent Counselor A an email this morning to recap the voice mail message I left her on Friday that she had not responded to:

"" I am not going to be able to bill Counselor B under you unless you provide me with a written explanation of the arrangement between yourself and Counselor B for my records and my attorney to look at.
 
I called the LPC board on Friday to check on cpt codes for 'consulting'. The LPC board says they do not know of a 'consulting' arrangement. They do not know of any arrangement called consulting. They said it sounds like insurance fraud.
 
I am sure you are not contemplating insurance fraud. I tried to reach a couple of insurance companies provider relations but lots of insurance companies were under water with the hurricane up north.
 
You had said that the last time Counselor B was there I billed it and it will be the same as then. But back then I was your employee and you bore the burden of accountability to the insurance companies. I did not have the responsibility of legality. I was able to just do as I was asked.
 
The legality would not have been my liability. Now it is.
 
Now that our relationship has changed and I am not an employee but a separate business, I have the responsibility to make sure all my actions, claim filings, are legal.
 
So with your written and signed documentation I will get legal approval. ""

Tried to sound like I  was giving her the benefit of the doubt since I was her employee for 5 years until October 15th when I went in with a contract and changed our relationship so I can take on other mental health billing counselor/clients.

I always come across as to formal and mean in my emails, I think.

Any thoughts?

thank you,
Barbara

DMK:
Formal is always best.  You didn't sound mean to me, you sounded professional.  Even with patients I love the most, an official letter from the office is always written formally.

You have to cover yourself because it will be you who is fined, or prosecuted for insurance fraud if you bill what you know to be illegal.  Ignorance of the law is no excuse. 

When I first read the post I thought "So when the patient sues Counselor B for malpractice, but Counselor A is on record as the charging physician, how do you explain?"

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