Manager never credentialed me with Medicare/caid

[BridgetJameson]

my office manager never credentialed me with medicare/medicaid and a few other insurance companies so the days I worked in surgery assisting, they never billed for my services, in addition anyone I saw from medicare was billed under my supervising physician.

Is this common practice?

[DizzyJ]

Uhh...I would say negative.  Why would they not want to bill for your services and it could be possible they committed fraud billing under your SP unless it was appropriate to be billed incident-to

[mgriffiths]

I wouldn't say it is common practice, but if you only see "incident-to" office visits then they don't need to credential you.  As for the surgery assisting, that makes absolutely no sense since in most (if not all) surgical specialties there is a billing modifier that can be applied when a PA or NP assists in a surgery.  If they are not including this then the practice is leaving significant money behind when they bill (think 5-6 digits depending on the number and types of surgeries).

[medwave]

This is not commonplace and you need to be credentialed and licensed in your State or Commonwealth. Credentialing can be a tedious and confusing task for providers and their staff. Done haphazardly, the process can become a nightmare. The Coalition for Affordable Quality Healthcare (CAQH) is the first step in credentialing for providers. Without forming a profile with CAQH and keeping your information current, insurance companies will not accept or keep your credentialing status as active. A national provider identifier (NPI) is a 10-digit number that every healthcare provider in the United States must obtain. It is used in medical billing claims and credentialing with insurance companies.

Edited September 4, 2019 by medwave