Are You Billing Under Another Physician’s NPI? Don’t!
Physicians should be aware that billing services under another physician’s NPI is generally prohibited. Engaging in such billing practices can result in severe legal repercussions. For additional insights, watch the video.
Cases to referenced:
West Virginia hospital to pay more than $300,000 for Medicare fraud
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Locum Tenens
Remember, there are very specific rules for Locum Tenens work and billing. This should NEVER be used when the other physician is in the office. Also, here are a few articles and videos regarding Locum Tenens billing (the only time that a physician can bill under another physician’s NPI).
Transcript:
As a physician are you performing services and then billing those services under another physician’s NPI? You shouldn’t be. There’s only one exception to that rule, and that’s if you’re doing locum tenens work or fill-in work and in that case, the other physician has to be out of the office and you have to be billing that with a Q6 modifier, and meet all of the requirements for locum tenens. We have another video and several articles on that and check that out at ilchiro.org. But most importantly, are you as a physician allowing others to bill under your NPI, or as a physician are you billing your services under another physician’s NPI, you cannot do this that is really getting dangerously close, if not right on the money to a textbook definition of healthcare fraud or insurance fraud.
In fact, there are a number of cases out there there are cases in West Virginia Hospital who did this, and organizations out of Texas, there are so many other cases. In fact, I’ll drop some links down below where you can see the Department of Justice actually actively goes after those who are doing this particular type of billing. Do not use your NPI to bill for another physician’s work. Interestingly, when we start looking at the delegation law in Illinois, and actually also covers this, in fact, what it says in the Medical Practice Act for delegation, which when someone else is performing some work for you, typically unlicensed or unlicensed or licensed who are not physicians, that’s really important who are not physicians who are billing underneath your license. That’s that’s delegation. And under the delegation rules in Illinois, you’ll find that it says quote, no physician may delegate any patient care, task, or duty that is statutorily or by rule mandated to be performed by a physician. In other words, examinations, adjustments, and things along those lines that you’re performing, those are required to be performed by a physician. And in those particular cases can’t be billed under another chiropractic physician or another MD, or DO or whatever, it doesn’t matter. They can’t be billed under their NPI.
You have to bill as a physician you have to bill your services under your NPI In other words, your NPI should appear inside box 24J. If you’re not credentialed, then at the end of the day, you have to wait to get credentialed or you’re going to be considered out of network for those particular services. Wait till you’re credentialed don’t bill under another physician to another doctor’s NPI for those particular services. We’ll catch you next week.
