Results 1 to 18 of 18

Thread: Can you bill Ins for a dr when a patient is seen by another dr?

  1. #1
    OptiBoard Novice
    Join Date
    May 2014
    Location
    Texas
    Occupation
    Other Eyecare-Related Field
    Posts
    4

    Can you bill Ins for a dr when a patient is seen by another dr?

    Hi i have a question and any help would be greatly appreciated :)

    If a patient sees a dr who is not in network with their insurance company is it okay to bill the insurance using another dr's name who is in network?

  2. #2
    Master OptiBoarder
    Join Date
    Jun 2000
    Location
    California
    Occupation
    Dispensing Optician
    Posts
    2,816
    Only if you want to be charged with fraud.

  3. #3
    OptiBoard Novice
    Join Date
    May 2014
    Location
    Texas
    Occupation
    Other Eyecare-Related Field
    Posts
    4
    Thats what i thought but the dr's here said there is a way to code and use both dr's names and it wouldn't be illegal

  4. #4
    Master OptiBoarder rbaker's Avatar
    Join Date
    May 2000
    Location
    Gold Hill, OR
    Occupation
    Other Optical Manufacturer or Vendor
    Posts
    4,401
    Who ya gonna listen to your doctor or the District Attorney? If you get caught who will have to put on the pink jump suit and do the perp walk.

  5. #5
    OptiBoard Novice
    Join Date
    May 2014
    Location
    Texas
    Occupation
    Other Eyecare-Related Field
    Posts
    4
    yeah i'm refusing to do it. i just wanted to make sure i'm right

  6. #6
    Master OptiBoarder
    Join Date
    Oct 2005
    Location
    new york
    Occupation
    Optometrist
    Posts
    3,749
    Quote Originally Posted by CME4SPECS View Post
    Only if you want to be charged with fraud.
    That is not necessarily true. There are some optical plans that approve the optometric/optician owner of the business. And all employees, as long as appropriately licensed, are allowed to examine or provide service.

  7. #7
    OptiBoard Professional nicksims's Avatar
    Join Date
    Sep 2011
    Location
    Denver
    Occupation
    Optical Laboratory Technician
    Posts
    176
    There have got to be some more details to this scenario that would be helpful. From your original question, it only sounds fraudulent. From those few details, there is no relevance then to "in" or "out" of network. Is there any other info you could provide?

  8. #8
    OptiBoard Apprentice
    Join Date
    May 2013
    Location
    Massachusetts
    Occupation
    Dispensing Optician
    Posts
    12
    When something is questionable, cover yourself and just don't do it. If the doctor wants to bill it, let them, and they can take the hit.

    I constantly see questionable things and when I'm asked to do it I say "My livelyhood isn't worth it, sorry!!!"

  9. #9
    OptiBoard Professional
    Join Date
    Sep 2011
    Location
    Ill
    Occupation
    Optical Retail
    Posts
    121
    Why did this pt see the Dr. that was out of network when you said there is one there that was in network or am I just missing something.

  10. #10
    OptiBoard Novice
    Join Date
    May 2014
    Location
    Texas
    Occupation
    Other Eyecare-Related Field
    Posts
    4
    There are 3 dr's and they're all in network with different insurance companies. Sometimes an employee will schedule a patient with a dr who isnt in network with the patients insurance.

  11. #11
    Master OptiBoarder
    Join Date
    Jun 2008
    Location
    Seattle WA
    Occupation
    Optical Wholesale Lab (other positions)
    Posts
    3,137
    Quote Originally Posted by erikatwelve View Post
    There are 3 dr's and they're all in network with different insurance companies. Sometimes an employee will schedule a patient with a dr who isnt in network with the patients insurance.
    Then it depends on the contract with each ins company regard a "fill in" Dr.

  12. #12
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
    Join Date
    May 2001
    Location
    United States
    Occupation
    Dispensing Optician
    Posts
    3,197
    Sorry I missed this thread earlier. I have been working a lot in this area, so can shed some light.

    This will vary depending up the plan. Many of the VCPs, including Eyemed and VSP have it stated in their contracts that any member seen in your office must be seen by a plan credentialed doctor, even on a fill in basis.

    On the plans that will allow you to have fill in (Medicaid/Medicare) you can use the Q6 modifier to signify a locum tenens. This means there is a reciprocal agreement between the rendering provider and the credentialed provider. All monies will be paid to the credentialed provider, and it is the credentialed provider's information that is on the CMS 1500 form. This also means that the credentialed provider is accepting liability for the services performed and the claim.

    There are a few plans (and you can do Medicare this way as well) that will allow you to enter the rendering providers information in Box 24J, and then use the BILL AS, (Box 33) to put the credentialed provider's information. You see this more with group settings, where they want the monies to be paid to the clinic, and not the individual provider.
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  13. #13
    Master OptiBoarder
    Join Date
    Jun 2008
    Location
    Seattle WA
    Occupation
    Optical Wholesale Lab (other positions)
    Posts
    3,137
    Great post!

    Quote Originally Posted by Jubilee View Post
    Sorry I missed this thread earlier. I have been working a lot in this area, so can shed some light.

    This will vary depending up the plan. Many of the VCPs, including Eyemed and VSP have it stated in their contracts that any member seen in your office must be seen by a plan credentialed doctor, even on a fill in basis.

    On the plans that will allow you to have fill in (Medicaid/Medicare) you can use the Q6 modifier to signify a locum tenens. This means there is a reciprocal agreement between the rendering provider and the credentialed provider. All monies will be paid to the credentialed provider, and it is the credentialed provider's information that is on the CMS 1500 form. This also means that the credentialed provider is accepting liability for the services performed and the claim.

    There are a few plans (and you can do Medicare this way as well) that will allow you to enter the rendering providers information in Box 24J, and then use the BILL AS, (Box 33) to put the credentialed provider's information. You see this more with group settings, where they want the monies to be paid to the clinic, and not the individual provider.

  14. #14
    Master OptiBoarder
    Join Date
    Nov 2009
    Location
    Somewhere over the Colorful Spectrum of Light
    Occupation
    Dispensing Optician
    Posts
    536
    Quote Originally Posted by Jubilee View Post
    Sorry I missed this thread earlier. I have been working a lot in this area, so can shed some light.

    This will vary depending up the plan. Many of the VCPs, including Eyemed and VSP have it stated in their contracts that any member seen in your office must be seen by a plan credentialed doctor, even on a fill in basis.

    On the plans that will allow you to have fill in (Medicaid/Medicare) you can use the Q6 modifier to signify a locum tenens. This means there is a reciprocal agreement between the rendering provider and the credentialed provider. All monies will be paid to the credentialed provider, and it is the credentialed provider's information that is on the CMS 1500 form. This also means that the credentialed provider is accepting liability for the services performed and the claim.

    There are a few plans (and you can do Medicare this way as well) that will allow you to enter the rendering providers information in Box 24J, and then use the BILL AS, (Box 33) to put the credentialed provider's information. You see this more with group settings, where they want the monies to be paid to the clinic, and not the individual provider.
    Best Answer!!!!!

  15. #15
    Master OptiBoarder
    Join Date
    Jun 2008
    Location
    Seattle WA
    Occupation
    Optical Wholesale Lab (other positions)
    Posts
    3,137
    I have seen some contracts limit the number of exams by a "fill-in Dr." to 2 weeks a year.

  16. #16
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
    Join Date
    May 2001
    Location
    United States
    Occupation
    Dispensing Optician
    Posts
    3,197
    Yes each plan can have its own specific rules. For state/federal insurances, such as Medicare, 60 consecutive days is the rule.
    "Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland

  17. #17
    Master OptiBoarder
    Join Date
    Jun 2008
    Location
    Seattle WA
    Occupation
    Optical Wholesale Lab (other positions)
    Posts
    3,137
    Jubilee, I anoint you our resident expert on such things.

  18. #18
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
    Join Date
    May 2001
    Location
    United States
    Occupation
    Dispensing Optician
    Posts
    3,197
    Thanks :) It wasn't a specialty I desired, but one I acquired out of need and happy to share.

Thread Information

Users Browsing this Thread

There are currently 1 users browsing this thread. (0 members and 1 guests)

Similar Threads

  1. AOA Backs Contact Lens Patient Safety Bill Sponsored by Kentucky's Rep. Whitfield
    By Wes in forum General Optics and Eyecare Discussion Forum
    Replies: 1
    Last Post: 10-25-2011, 07:15 PM
  2. Remembering Bill
    By Oha in forum General Optics and Eyecare Discussion Forum
    Replies: 0
    Last Post: 10-10-2003, 09:12 PM
  3. Save BIG On Your Lab Bill
    By tyancy in forum Optical Marketplace
    Replies: 0
    Last Post: 04-24-2002, 08:59 AM
  4. Cut your Lab Bill 50-70%
    By sgreen in forum Optical Marketplace
    Replies: 0
    Last Post: 06-01-2001, 05:55 PM
  5. Bill does it again.......
    By John R in forum Just Conversation
    Replies: 13
    Last Post: 11-20-2000, 04:54 PM

Tags for this Thread

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •