Medicaid Number Question (Billing)

[DrTacoElf]

I'm asking this for my friend (he is too lazy to make a post).

He just graduated, got his Georgia Dental License and NPI number. He is in the process of applying for a medicaid number. While he is waiting 6 weeks for this number to be issued is it illegal for him to practice and use another providers medicaid number to bill with. For instance he will do exams and it will be coded with the other dentist's medicaid number. The practice is 100% medicaid.

Thanks!

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[DrJeff]

I'm asking this for my friend (he is too lazy to make a post).

He just graduated, got his Georgia Dental License and NPI number. He is in the process of applying for a medicaid number. While he is waiting 6 weeks for this number to be issued is it illegal for him to practice and use another providers medicaid number to bill with. For instance he will do exams and it will be coded with the other dentist's medicaid number. The practice is 100% medicaid.

Thanks!

I had a similar thing in CT a while back where my partner was an enrolled CT medicaid(HUSKY in this State) provider and my application was being processed. What they(Husky admins) advised my practice to do until I got my provider number was submit the claims under my partner's provider number and then once payment was received at my office deal with the proper account allocation of those funds. A bit of a pain in the ***** for my office manager for a few weeks, but pretty a straightforward solution they(Husky) proposed as a way to get care rendered.

If your buddy is in with a group where someone has a Georgia provoder number, just have him call up the folks who manage Georgia's plan and see if it's okay with them. Then if so, I'd REALLY stress to your buddy to document what patients/procedure claims he should be getting $$ for on a daily basis and keep track of them with the office manager until he has his provider number and ALL of those claims have been paid in full (in many cases with insurance companies it may very well take a couple of months for all the claims to have been processed and paid from when the date of service occurred.

 

[mike3kgt]

I'm asking this for my friend (he is too lazy to make a post).

He just graduated, got his Georgia Dental License and NPI number. He is in the process of applying for a medicaid number. While he is waiting 6 weeks for this number to be issued is it illegal for him to practice and use another providers medicaid number to bill with. For instance he will do exams and it will be coded with the other dentist's medicaid number. The practice is 100% medicaid.

Thanks!

I would be VERY wary of doing this, even with verbal permission of the state medicaid office. Can you use bill Delta with another doctor's NPI for work that YOU did, sign prescriptions for narcotics using somebody elses DEA #, or practice dentistry under somebody else's license # (if you didn't have one)??? ... nope, that'd be fraud. I don't think the medicaid billing # would be any different. If your "practice group" or "corporation" has a NPI and medicaid # that they will bill for you, then that would possibly be ok.

At a bare minimum, I would want a certified letter from the state medicaid office outlining what they recommend doing, if they do (i.e. billing under another provider #). I would imagine that it would be state-by-state, possibly in DrJeff's state, it was okay at the time there. I can assure you that this would not be the case in Ohio.

Seriously, if it were me, I would not touch a patient until everything is clear with the credentialing. The practice I was at not too long ago waited for me to get credentialed by Medicaid prior to beginning work on those patients, I saw cash/private benefit patients until I had obtained the "privilege" of seeing Medicaid patients.

The risk of Medicaid-fraud is bad enough when things are seemingly legit and normal. Why take this risk? Even the mention of this type of proposal would scare me from that practice.

Before you see Medicaid patients, go on to dentaltown and research Roy Shelbourne in Virginia and Anthony Sanchez in Wisconsin and see what has happened to them because of billing errors. It would really open eyes into that scary world.

 

[DrTacoElf]

Thanks for the input. Yeah I read the Roy case, crazy