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Thread Topic: Billing Professional Services Within a Group Practice
Topic Originator: Jami
Post Date April 4, 2016 @ 12:45 PM
Billing Professional Services Within a Group Practice

April 4, 2016 @ 12:45 PM Reply  |  Email Friend   |  |Print  |  Top

I am currently in my first billing job. I'm actually a certified coder and don't know a whole lot of the ins and outs of billing practices. All I do know about basic billing practices, I've learned from our insurance coordinator and Google.

One thing I've had an issue with in the 3 years I've been here is how our physicians bill their hospital services. I've been told this is how they've always done it so I just go along with it. What they are doing is hard to explain, but I'll do my best.

Say Dr. A has a patient they have in the hospital. Dr. A provides E/M services to this patient for the majority of their stay. However, on their days off, Dr. B and/or Dr. C provides the E/M services (whichever doctor is the on-call). The doctors like to submit their own charges. When they do, this entire visit is billed under Dr. A.

We recently received a denial from UHC after I submitted progress notes from a visit that included notes from multiple of our doctors, billed under one doctor. The denial stated that the rendering provider was not the billing provider.

I just put the charges into our system and I'm not sure how it comes across on the claim, but I've been told they always include the individual NPI and our group NPI. I've also been told because these doctors are under the same group NPI that it should be okay to bill this way.

Can someone perhaps clarify this for me and let me know if something is being done wrong?

July 14, 2016 @ 9:12 AM Reply  |  Email Friend   |  |Print  |  Top

You would have to bill the NPI of each provider with a modifier. I am not sure what modifier it is though. The group practice NPI will also be on the claim. The reason for that is because if a Dr is not signed up with MCR or any other insurance then he could use another Drs NPI to bill and that is illegal.

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