General Category > General Questions

Provider Billing Another Provider

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barb2512:
I just spoke to Counselor A who says she is a PLLC which means, she says, that she is a business that can have employees.
Second point- how does this mean that I can bill for sessions her 'employee' has? I am assuming someone on the panel here will know how that works.
I assume it is like a facility, like a regular doctor's office where the nurse or PA sees the client. How is it then billed to the insurance? Does the name of the person providing the service go on the claim form or just the facility name?
Does the person providing the service need to be registered with the insurance company or just the facility?
Any help is greatly appreciated.

Thank you,
Barbara

JenniferPT:
This is called, in the field, "creative billing."   It is illegal.   just like it is illegal to bill for an individual session when the counselor knows full well they are seeing a married couple, because family sessions are not available on their insurance plan.  I'm surprised how many therapists do this.   Or if a partner isn't insured, they see that person as the insured.   Blows my mind how many times I have new patients call and get miffed with me because "our last therapist did it."   Well...that's nice, but I like my bed and cooking my own dinner.   I have no desire for a jail mattress and food cooked by Bertha who is in the joint for 50 years for murder. 

Print out some legal stuff for her to read and go over and ask her if this is worth her livelihood?   Either Counselor B gets credentialed and in network and bills as herself, of you walk away from this lady.   She's setting you up to be legally responsible for jail time and huge fines.   

Anyone out there is a fool to think the insurance companies don't find this stuff out.  Tons of fraud cases available to see online, for medical billing.   

barb2512:
Thank you. Every time Counselor A explains it to me I can still come up with a roadblock.

Thank you.
Barbara

DMK:
The other thing to think about is this...  If the patient sees Counselor B and sues them for malpractice, how do you explain the billing to Counselor A? 

Michele:
Being a PLLC doesn't change the laws/rules that one provider cannot bill under another providers name/numbers for services provided.  The only time that is legal is if the billing provider is supervising/overseeing the care of a provider under a legal situation.  For example, a PT has a PTA working for them but they are in the room supervising the care given to the patients.

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