We had a denial from an insurance regarding Insufficient billing. The insurance company stated, "The services were billed by a physician other than the physician who furnished the services. Payment may only be made to the physician, practitioner, or supplier who furnished the service. The records submitted the technical study was performed by a physician other than the billing physician".
Example of situation:
A patient was seen by an NP and had an office visit and a chest x-ray done. We bill for the Technical component only of the cxr. The NP’s note is always co-signed by a supervising physician. We bill the claim with both the NP and the supervising physician. The report that we receive from the Radiologist that does the PC has the physicians name on the report. The claim we submit would have the NP and co-signing provider with the office visit and cxr billed.
However, in some instances the NP’s normal supervising physician may be off and another physician co-signs the note, but the report from the radiologist has the name of the normal physician on it, not the one covering on the day that the service was provided. We bill the claim with the NP and the co-signing provider with the office visit and cxr, not the provider listed on the report.
Does it matter who’s name is listed on the professional component of the report?
ANY help would be greatly appreciated.
cm@rlin