Can one provider bill under another provider?
Asked by: Simeon Armstrong | Last update: June 14, 2025Score: 4.2/5 (51 votes)
Can a provider bill under another provider?
Billing under another provider's name and NPI without complying with Medicare's strict requirements can carry significant penalties, violate commercial payer contracts and subject an organization or physician to criminal liability under federal law.
What is dual billing in healthcare?
Double billing: Companies cannot attempt to collect on medical bills that have already been paid by the consumer, insurance, or a government program such as Medicare or Medicaid. This practice can coerce consumers into paying twice for the same service, causing significant financial harm.
Can physician assistants bill under the supervising physician?
Yes, most do. Some carriers bill for the PA directly, while others bill through the supervising physician.
Can two providers have the same NPI?
To maintain compliance with group NPI regulatory requirements, independent nurse practitioners must ensure that all healthcare providers and organizations within their practice have a unique individual NPI and use the same group NPI when billing for services.
The dangers of billing under another provider's NPI
Can you bill under a group NPI?
Group NPI billing benefits multi-provider practices, clinics, and healthcare organizations. It allows for billing under a single identifier, simplifying administrative tasks and potentially enhancing the efficiency of claims processing and payment collection.
Can a physical therapist bill under another physical therapist?
PTs cannot bill incident to other PTs.
Additionally, in some cases, PTs in medically underserved or rural areas can take advantage of the arrangement previously referred to as “locum tenens.”
What is supervising provider in medical billing?
The Supervising Provider is the individual who provided oversight of the Rendering Provider and the care being reported. An example includes, but is not limited to, supervision of a resident physician.
What is incident 2 billing for physician assistants?
What Is Incident-to Billing? Incident-to billing allows NPPs to provide follow-up services under the direction of a supervising physician and bill under the doctor's national provider identifier (NPI) number, resulting in a greater Medicare reimbursement rate.
Does a supervising physician have to be on site?
(CCR 3516(b)) Schedule II-V Supervisory A supervising physician shall be available in person or by electronic communication at all times when the PA is caring for patients.
Is double billing illegal?
Double billing is one of the most common billing mistakes that lead to healthcare fraud charges, along with unbundling and upcoding.
What is an example of double billing?
Double-billing occurs when a provider attempts to bill Medicare/Medicaid and either a private insurance company or the patient for the same service/treatment, or when two providers attempt to get reimbursed for services rendered to the same patient for the same procedure on the same date of service.
What is dual invoicing?
Double invoicing, or duplicate invoicing, occurs when a business sends duplicate invoices to a customer — i.e., two invoices for the same goods or services provided. Sometimes, the invoices have the same purchase order number, date, and invoice number, making it clear that they were received at least once before.
Does Blue Cross Blue Shield allow incident to billing?
Does BCBS allow incident-to billing? Blue Cross Blue Shield (BCBS) does allow “incident-to” billing, but it is subject to specific conditions. Generally, only providers who are not offered network participation can bill incident-to services under a supervising provider's contract number.
What is a reciprocal billing arrangement?
It is common practice for physicians to set up reciprocal billing arrangements and to do so with more than one physician. For Medicare purposes, a reciprocal billing arrangement is: ▪ An agreement between physicians to cover each other's practice when the regular physician is absent (usually a two- way street)
Does Cigna allow supervisory billing?
Aetna and Cigna allow supervisory billing in all states without restrictions. However, as of October 1, 2024, UnitedHealthcare (UHC) and Optum will permit supervisory billing only in the following states: California, Colorado, Iowa, and Massachusetts.
Can a PA bill under another physician?
The PA is not considered an independent Medi-Cal provider. The billing for covered medical services provided by a PA is submitted under the (Medi-Cal enrolled) physician's name and identifier with a modifier “U7” which is used to indicate the service was provided by a PA.
How to bill under a supervising physician?
Include direct supervision attestation statements for “incident to” billing arrangements. Permissible “incident to” billing requires direct supervision from the supervising physician. These statements should document how the supervising physician supervised the non-credentialed physician during the patient encounter.
What is the 52 modifier in medical billing?
Modifier -52 is used to indicate partial reduction or discontinuation of radiology procedures and other services that do not require anesthesia. The modifier provides a means for reporting reduced services without disturbing the identification of the basic service.
Can a physician bill an incident to another physician?
Physician-to-physician incident to billing
In these situations, incident to guidelines are still required to be followed; therefore, the billing/supervising physi- cian must be in the office suite and the performing physician cannot change the billing/supervising physician's POC.
What are physician assistants not allowed to do?
While physician assistants can do many things, they cannot perform all the duties of a medical doctor. For example, physician assistants can assist in surgery, but we cannot perform surgery. Physician assistants do not become PAs as a stepping stone on their path to becoming medical doctors.
How much does a supervising physician cost?
How much does a collaborating physician cost per month? Prices will vary depending on your specific practice but are typically in the range of $500-1200/mo.
Can a fellow bill for services?
For the specialty in which the fellow is studying, s/he is treated as a resident; i.e. you don't bill for those services under the fellow's name. However ... occasionally you may have a fellow who is already board certified in a different specialty and s/he may be billable in that area under the fellow's own NPI.
What is modifier 59 in medical billing?
The CPT Manual defines modifier 59 as: “Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a. procedure or service was distinct or independent from other non-E/M (Evaluation/Management) services.
What happens if a provider is not credentialed?
Financially, services provided by non-credentialed physicians may not be eligible for reimbursement by insurance companies, leading to significant revenue loss. Furthermore, the reputation of both the physician and the healthcare practice can be damaged, undermining patient trust and professional reputation.