Medicare Compliance & Reimbursement - 2010 Issue 42
Reader Questions: Can You Bill Under the 'House' Doctor?
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Article Overview
This article addresses a common billing question involving radiology services and physician identification within a group practice. It explains the general billing issue, why the arrangement raises compliance concerns, and what provider information is used at a high level when submitting the claim. The piece is aimed at coders, billing staff, and practice administrators who need to understand proper claim attribution and avoid improper billing practices.
Why This Topic Matters
Correct physician attribution affects claim accuracy, compliance, and fraud risk. The article is relevant for practices that manage radiology billing, group billing structures, and provider enrollment details.
What You Will Learn
- How provider attribution works in a group practice setting
- Why billing under a different physician can create compliance concerns
- What general provider information is used on the claim
- How out-of-network status can affect billing questions at a high level
Who Should Read This
- Medical coders
- Billing specialists
- Practice administrators
- Compliance staff
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