Discover the Best Physiotherapy Bill Format for Legal Purposes

Physiotherapy bill format for Legal

we get a number of calls uh from uh new doctors who are starting their own practices maybe they were an associate before and and uh and they're talking to us about hiring new associates and how that billing process works and we're seeing this come up again and again and again we've seen it over the years but we've seen a growing trend over the last couple of years and how all of this works and so you know in short what we're going to talk about is using your mpi as the principal chiropractic physician to bill for all services performed in your practice even those performed by other physicians that's an important distinction of course we can talk about delegation we'll briefly do that but when you're billing other physicians works or exams adjustments etc under your npi in box 24j so talking about the rendering provider box 24j portion of the claim form i've given the executive summary for this entire video it's going to be really short don't do it that's that's the short version of exactly what we're going to talk about in today's video do not bill other physicians work under your npi in box 24j uh now why is that well there's a number of number of things that come into play especially we get this question a lot well but what about delegation i delegate to uh to unlicensed and licensed staff um why can't i delegate and just say that it's delegation well there's a number of reasons but i'll just cut to the chase uh the medical practice act in its delegation provisions only allows you uh uh to uh to delegate certain tasks in fact specifically it says no physician may delegate any patient care task or duty that is statutorily or by rule mandated to be performed by a physician i mean we can cut cut to the short chase here and that is exams uh x-rays and uh adjustments obviously those are required to be performed by physicians of course x-rays uh you can have uh you can have uh certain specifically qualified staff uh that may be able to do that as long as they're properly certified by the state but i'm talking really exams and adjustments and we see this a lot uh where they're billed under a single provider's mpi now this is done uh sometimes to to avoid the short-term uh hassles or delays in regards to credentialing uh for a new doctor that may be coming on and some of the processing delays there but in short don't do it so one delegation we covered that additionally this is really important whenever you put that in there what that line says if you look at that box very clearly it says it's the rendering provider's id so the doctor who's actually performing the task their npi must go in box 24j that is really really important now i'm not talking about box 32 and box 33 that's the location and billing information that would be a lot of times your group npi for that particular location or where the billing uh where the billing uh payments would go um that's different that's down below i'm talking about the rendering provider id do not bill under a single provider's number don't do it so one is it says rendering provider so it actually has to be the person who's performing that task and and this is so now we start getting into all the nuance of this and some of the problems one is when you sign that claim form in box 31 you're agreeing everything on the claim form is true and accurate and everything on the back all the statements on the back one of the statements on the back is very very very clear any person who knowingly files a statement of claim containing any misrepresentation or false incomplete or misleading information may be guilty of a criminal act published a punishable under the law and may be subject to civil penalties so you know of course the consequences are grave additionally there's additional liability problems that very well could arise um with malpractice carriers and insurance and if there's a question of fraud many times insurance carriers will back off because those are exclusions within your within your policy and so fraud's the tough word is it always fraud maybe maybe not it's a question of intent but quite candidly if you're trying to avoid finding out or um i don't want to know anymore and so i'm just going to continue to do it the way i've always done it or i'm just going to do it because this is how i was taught by the my previous employer all of those you know aren't gonna be defensible for the problem uh they might be defensible for a fraud but let's be honest uh you would have to defend it and which means it would be in court and so some people are saying well you know how am i gonna ever get caught well here's there's a number of ways that that can happen one is and it's just a simple random audit no big deal maybe a risk assessment on it maybe it's for the carrier not for you or the claim form shows one provider is a rendering provider uh um id identified on the claim form but then the note is signed by a completely different doctor now if you're also signing the the the the documentation that was uh that was put together by the rendering provider and you're not that rendering provider that that you're again you're going to be on dangerous grounds most likely entering that ground of fraud and so uh you have to be careful there but in the billing claim form box 24j has to be the person who is actually performing the task all of these things are important how else could you get caught well let's be honest if it's all billed under one provider maybe you have three associates that are working for you that's four doctors uh simple math says sometimes it just doesn't work that many adjustments that many exams and that many mo physical therapy activities maybe there are timed codes that are happening and the math doesn't work to be able to justify payment and that could trigger an audit as well and so yes these things are things that come up uh we have seen this happen before where there's recruitment and although we have the the the 18 or soon to be at the beginning of next year 12-month limit on recruitment there is an exception to that rule and that is when they can prove fraud and so ultimately if you're fraudulently submitted your claims and again in violation of what you agree to when you sign box 31 uh with that uh knowingly files a statement of claim containing misrepresentation or misleading information um all of that comes into factor and if they're able to prove fraud then they can recoup well beyond uh that limited 18 or 12 month time frame and so really the short answer is this weight uh two things that matter and and we can talk about two primary carriers because uh they make up the vast majority of the insurance world and in illinois and that's one medicare medicare allows you the moment that you have actually submitted your clean cl your your clean application for uh for participation medic care you can begin to see medicare patients right you hold your claims and once you're officially approved then you can back bill back to the point of the application now most carriers in blue cross blue shield is one of them don't necessarily have that rule they want you to be fully credentialed so until you're fully credentialed by the insurance carriers most of them you can check with each one but uh but uh but it appears the blue cross blue shield is one one of them that requires you to be fully credentialed before you can actually bill as an in-network provider up until that approval point uh you still are considered to be a non-participating provider and so you'll have to be a non-participating provider until that credentialing takes place but don't use a stop gap in the meantime and bill under the incorrect rendering provider id number this is really important we see this a lot uh hopefully this helps clear up some of the challenges that we see on bringing on new associates or how your billing practices work and we will catch you next week take care