Reader Question: Understand These NPI Basics For New Providers

Why This Topic Matters

The topic is important for practices onboarding new clinicians because early billing decisions can create compliance risk if claims are submitted before enrollment or credentialing requirements are satisfied. It also helps administrators, billers, and compliance staff understand the general framework surrounding claims submission for new providers.

Article Sections

1. Question

   Introduces a practice scenario involving a newly hired provider, credentialing status, and questions about how services may be billed during the onboarding period.

2. Answer

   Addresses the compliance and billing concerns raised by the scenario and discusses the general appropriateness of billing under another provider’s identifier.

3. Solution

   Outlines broad options for handling patient visits while the new provider’s enrollment or credentialing is pending.

4. Remember

   Highlights a general caution about reporting services under an existing physician’s identifier in combination with locum tenens terminology.

5. Here’s why

   Provides general context on the meaning of locum tenens and references Medicare guidance relevant to covering physicians.