Comments on: Can a Provider Bill Insurance Under Another Providers NPI?

By: Hector Monzalez

Hector Monzalez — Wed, 09 Dec 2020 07:07:23 +0000

An NPI is a unique identification number created to improve the efficiency and effectiveness of electronic transmission of health information.

By: Stan

Stan — Thu, 07 Nov 2019 13:06:24 +0000

I have a similar question. I work at an office that owns several locations. They often see patients at one location but then bill through another location (because they have better contracts there). I’m certain this is illegal and when i posed the question to management they said it wasnt.

By: Antonia

Antonia — Tue, 15 Oct 2019 16:39:49 +0000

Actually it is not fraud and is very common so long as that clinician who is contracted and credentialed is providing supervision to the associate clinicians.

By: HEATHER BERRY

HEATHER BERRY — Fri, 10 May 2019 16:02:37 +0000

What if the practice is an S corp with a business NPI? can ASW work under a Business NPI?

By: Joan

Joan — Fri, 18 Jan 2019 13:16:17 +0000

I work in a small OBGYN private physicians office who recently worked out an agreement with another physicians office (who is moving out of state)to begin referring his patients to our practice. For a period of time (undetermined) the physician who is moving out of state will be seeing some of these referred patients (who are his patients but will be new patients for our practice). The owner of our clinic as well as the accountant for our practice both state that it is ok for me to bill the physician who is moving out of state under MY doctors NPI. I say that this is fraud but the accountant states that it is ok because these patients will/are new patients to our practice and the physician who is moving out of state will be paid as an employee of our practice. Help….. please as I am extremely uncomfortable with billing in this manor.

By: randy

randy — Fri, 21 Dec 2018 09:53:25 +0000

I joined forces with another counselor to become a partnership. Needless to say this never happemed. She was getting all of our money into her account when we were reimbursed though Medicaid/ private insurance and paid me out of personal checks whenever and however much she felt like (I didn’t get much at all.” I also found out that her anme is on a boll of my client as the clinican and she never had this person as a patient.

By: J'me

J'me — Thu, 25 Jan 2018 18:56:55 +0000

I was made aware of a clinic who is allowing their LMHC’s to see patients with Medicare and billing it under the LCSW’s NPI as the rendering. Can they do this? I have tried to research it and nowhere do I see this is in compliance as LMHC’s are not recognized by Medicare and LMHC’s do not show to be able to render services incident to the LCSW.

By: Anthony Centore

Anthony Centore — Mon, 13 Nov 2017 21:49:18 +0000

In reply to Danielle.

Sometimes it is, sometimes it isn’t. To check, I’d reach out directly to the payers to confirm that what you’re doing is kosher.

By: Danielle

Danielle — Mon, 13 Nov 2017 21:06:43 +0000

I Currently am employed with a company doing Mental Health and Addiction services. I have several clinicians that have NPI numbers that are not independently licensed and not on Insurance panels. The COO wants to hide those NPI numbers that are not paneled but are rendering the services and Put the Independently Licensed and paneled NPI numbers on as the rendering.
I feel this is fraudulent. Would appreciate any advice that could be given.

By: Teresa Maylor

Teresa Maylor — Sat, 07 Oct 2017 03:37:20 +0000

Can I be a rendering provider for more than one group at the same time? There are different part time positions.

By: Beth Staropoli

Beth Staropoli — Thu, 06 Apr 2017 22:28:38 +0000

In reply to Natalie Errante.

In regards to that answer, what if the company billed a claim under another physician within the practice (not supervising physician), but different location, because the physician is part of a hospital and gets higher rates (under certain insurances)?

By: Thomas

Thomas — Mon, 13 Mar 2017 19:44:16 +0000

can I sue someone for billing using my NPI number after leaving that company?

By: cindy

cindy — Sun, 13 Dec 2015 02:50:20 +0000

Have been billing for a therapy company and as other comments, the company bills services under npi #s other than the provider that is actually providing the service, until the new provider is credentialed. The mgr has been told repeatedly that this is ok because the billing is under the “supervising” therapist. Is this ok if the therapist npi # that is used for billing is located at the same clinic ? In some cases, the therapist that is treating and the therapist npi that is being billed are not at the same location/clinic.

By: Amanda Wingert

Amanda Wingert — Thu, 03 Dec 2015 15:03:54 +0000

I was wondering I had started a job back in August as a Centralized Biller for a company that provided PDN and SNV for longterm home health pediatric children. On the 3 day of employment, I noticed that the NPI numbers were being shared selectively for certain states and for different locations. The average mileage was over 333 miles. Obviously there was a variance with counties with that great distance. I wonder why would a company share or borrow a NPI and Provider ID from one location to the next? The services that were rendered-provided were not of that billing location. I was put in a compromising situation to change and transfer patients from one location to the next because the true location did not possess a NPI and provider license. Essentially I resigned. I did not want to contribute to this unethical illegal billing practice. I question why transfer a patient when their address and nothing changed. The person that was training was not merging chart transfers essentially resulting creating a duplicate patient chart. This made me wonder if this was a way to camaphlague what they were doing. Because the only way to identify a duplicate chart is by location. Otherwise it would not show up. I inquired about why they were borrowing and billing under same NPI number where services were clearly not rendered within that specified county and they tried to minimize my concern and justify that it was legal. This I thought was important for Medicaid and Medicare. I asked for supported documentation to see if they could provide me the material that says it is alright and ethical to bill like that and I got treated very rudely and bullied to resign. They would not provide the documentation. This company got in trouble for Federal fraud 3 months prior to that and clearly they are trying to get around the system in other ways.

It was my understanding that a NPI is an individual number and identifies location- provider specific. Medicaid and Medicare CMS guidelines I can’t seem to find it written that they need a number and that it can or can not be shared. I know some commercial insurances specifically say that you need an NPI number per location, what it is they don’t realize it is shared and mirrored. Something really doesn’t feel right about any of this. This has affected so many employees job and ethics that a lot of them resigned. The thing is they had 2 different departmental steps to billing processes when one would release a bill it would go to another department and then the billing would be manually changed before it was truly released. A centralized biller would intake the information, referral, POT point of care, audit, obtain authorization, release when everything is obtained and then it would go to another department to actually bill.
I appreciate your thoughts.

By: Nicole

Nicole — Wed, 22 Jul 2015 20:02:44 +0000

Hi,

I just started at a psychologists office as the practice manager. I am trying to reestablish rules/regulations etc as it was out of control before. We have 2 dr.s here who often do evals and such for bariatric procedures. 1 of them sees the patient for the eval and the other does thereport side. They also see patients for individual counseling. No matter which circumstance, ALL billing is ALWAYS done through only 1 of them. I am afraid that they are committing fraud unknowingly. Please advise so I can rectify the situation immediately!!!

By: Gilbert Jones

Gilbert Jones — Tue, 09 Jun 2015 03:59:36 +0000

I have been working with a PhD since I was gathering my hours for my license and have recently passed the EPPP. I want to continue working with the company but she wants to continue to bill under her Medicare number even though I have my own. Is this fraud and do I have anything to be concerned about?

By: K Madi

K Madi — Tue, 17 Feb 2015 17:16:23 +0000

I was wondering if you have any published guidlines supporting your opinion and hope you can share. If you mean by “delegation of services” :

1. Incident-to billing: The supervising billing physcian has to be available and physically present at the location of service.

2. Locum tenem or reciprocal billing agreement: It can not go more than 60 days and modifiers Q5 or Q6 should be used.

By: Natalie Errante

Natalie Errante — Mon, 02 Feb 2015 19:25:18 +0000

This is done often and if you call the insurance companies they will tell you this. It is not fraud it is called “delegation of services”. Or was I do believe it is called something else now. EHRs are even designed to do this as well. Some insurance companies will have you add a code to signify it is someone else giving the services and others will not. This is used a lot in states where PAs can not bill on their own. Hope this helps.

By: Anthony Centore

Anthony Centore — Sun, 23 Jun 2013 15:20:51 +0000

In reply to Susanne Smith.

Susanne,

It feels wrong because it’s possible the practice you’re working at is committing insurance fraud. If you need confirmation, you can call the insurance company and present them a hypothetical situation identical to what is going on in your practice. Or, you can just get the heck out of there fast… if you ever want to work with insurance companies again, I’d recommend making sure that your billing situation is above board. –I hope this helps!

By: Susanne Smith

Susanne Smith — Sun, 23 Jun 2013 15:12:55 +0000

There are 3 LMSW ‘s billing under one provider number until they get there provider numbers. 3-4 months wait. I tool over billing recently and after reading this it sounds fraudulent. I asked them but none seem to think its a problem. But it feels wrong. All the reports show him billing but hes never there. What do I do? I need the job but if its illegal not sure I can be part of it