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Click here for more sample CPC practice exam questions and answers with full rationale

Billing for non-credentialed Nurse Practicioner

We have a new NP that is not yet credentialed with all payers (only MCR and MCD). The physician wants to bill everything under his NPI. Not all of the encounters meet incident to requirements, some are new patient visits or new chief complaints. Also, not all payers go by MCR guidelines on incident to billing.
Is there any LEGAL way to bill under the doctor’s NPI until the credentialing comes through for the NP? I’ve searched exhaustively and I can’t find any clear answer.
Can these charges be billed with SA modifier?

Please help!

Medical Billing and Coding Forum

Billing a Non-Credentialed Provider under a Credentialed Provider’s NPI–HELP

I am currently in the end stages of the interview process to become the lead medical biller at a smaller private practice. I have a friend who works there who mentioned last night I would need to be comfortable billing non-credentialed providers under the credentialed providers. She stated the credentialed providers will step into the office visit for a moment and that makes it legal to bill as listed above. I am HIGHLY unsure of the legality of this and do not want to start my career as a medical biller performing unethical practices that might be considered fraud. I understand each payer is different and it could depend on the individual contract. Can someone help make this more clear for me.

Thanks in advance!

Medical Billing and Coding Forum

Continuous Billing of non-credentialed physician

We have ppl in the MCR credentialing process at this time. They are not yet credentialed but their claims are continuously being sent so that we are not holding claims. I thought there was something out there about repeatedly sending claims that you know won’t be paid? I may be having this confused with something else but does anything about this sound familiar to anyone? TIA

Medical Billing and Coding Forum