So for starts, I am an NP not a PA but the details I think would be the same.
Background: I work at a clinic with no onsite physician, ever. The second clinic has an MD on site, and is about 15 minutes away.
Situation: We use ECW, everything is set so that the Pay to, Rendering and Supervising is set to one of the MDs, with the incident-to box not checked. Now I don't know how to see what is sent electronically, but when I view the 1500 form, they all have the MD as the referring physician, and IF NPI numbers are on the form, it is only his in the rendering field (24J). Sometimes the only NPI number is the Business NPI in boxes 32a and 33a. Sometimes, no NPI number is on the form at all.
Now, I have no billing training at all, but it looks to me as if they are billing these as if he is seeing the patients or somehow the business is seeing the patients. I can't believe if I am the sole provider in the clinic, my NPI number shouldn't be on the forms somewhere. It also does not look like their is a 15% reduction in fees, which would show if they were billing me as the primary.
This has me freaked out, so any help, suggestions etc. are welcomed. If it is fraud, I am reporting it immediately, as I do not want to lose my right to practice over their illegal activity.