I have a sit down meeting with my supervisor and I need to come up with as much source material as possible to address the following:
Why billing a non credentialed provider's services under a credentialed provider (as rendering) is not a good idea for PRIVATE insurance. The information is abundant on why it's a bad idea for Medicare, but I need to give facts to support the need to stop doing this on private insurance carriers.
So far all I've found is from the United Healthcare contract, "...you will assure that a member of your professional staff who has not been approved or is not in good standing under our credentialing program will not provide covered services to our customers. In the event that professional does provide covered services, you will not bill us, our customer, or anyone acting on our customer's behalf for the service, and you will assure that the professional also does bill for the service..."
I would also greatly appreciate some examples of worst-case scenarios of doing this (I.E. audit, terminated contracts, or other penalties). Thank you all so very much for any assistance you are will to give.
A Concerned Medical Biller