Author Topic: Used wrong rendering but CORRECT group  (Read 198 times)

cleefoasis

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Used wrong rendering but CORRECT group
« on: January 26, 2021, 05:25:47 PM »
Hi all,

The practice is out-of-network with all insurance companies, but we send invoices (superbills) that include NPIs for the clients to submit to insurance. It looks like some invoices may have been sent with two of our providers having swapped NPI's; however, they included the CORRECT group NPI.

A few questions in regard to this:
a) Are there negative ramifications for the individual who's NPI number was used incorrectly

b) What are the health insurance implications of an incorrect rendering NPI number being used- or do they even use the individual # (do they use the organizational #?)

c) Is there a concern that we could be accused of fraud?

d) Any other ramifications?

Thanks in advance to all that help, it is greatly appreciated!! :)

Michele

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Re: Used wrong rendering but CORRECT group
« Reply #1 on: January 28, 2021, 06:25:19 PM »
How many invoices (superbills) were sent incorrectly?  Are the two NPIs that got swapped for the same provider type?  (MD, PhD?)  I don't think you have to worry about fraud since it wasn't done to increase reimbursement and it was an honest mistake, but I would try to rectify it.  Maybe send corrected invoices out to the clients with an explanation. 
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Re: Used wrong rendering but CORRECT group
« Reply #1 on: January 28, 2021, 06:25:19 PM »