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Posted By Gracie Ermitano on 01-12-2018, 03:35:45 in Ob-Gyn
Good afternoon Melanie! Happy holidays to you! I am wondering if we have certain guidelines for other physicians covering for surgery. The scenario was was that another physician from a different group practice covering for another physician. Billing provider different from the provider's name on the dictation and they belong to different group practice. Any information you may have, can you kindly share it with me? Thank you. Respectfully, Gracie
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Posted By Melanie Witt on 01-12-2018, 14:18:19
Unlike global OB which is an all inclusive service, surgery is a one-on-one event by the surgeon who performs it, not whose patient it is. In global ob inclusive billing the payer does not care who does the actual delivery so long as there is some agreement in place that the covering MD is accepting the idea that he/she will not be billing and the money goes to the practice. In surgical cases, however, if the covering MD ended up performing surgery he/she would bill for that surgery under their own NPI, not that of the original physician and only the operating surgeon should be dictating/signing off on the operative note. As to who gets paid, that will be up to the payer and I hope you have a formal agreement in place for this covering. However, keep in mind that if the covering MD is not credentialed with the payer, no agreement will get you paid. There are no black and white guidelines for this as each payer is different, but this is what my experience with these cases has taught me. There are also legal implications for a physician who performs the procedure, but allows another to dictate the operative note as if they had done it. Be very careful here is my best advice.
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