Performing Procedures Under Employer

Panacea Financial Contract Review
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Dansk703 said:
I have been with a new practice for the last 6 months or so and because of lag in credentialing with certain insurances I am being asked to perform injections and seeing patients under my employers EMR log-in (essentially under his name). I had been doing this for a few months to start as I understood there was a grace period of typically up to 90 days as long as there had been a submitted application for approval with the insurance companies. Every time that I would do procedures or see patients under his name, I would always sign my name on the chart. However, as it has been past the 90 days I have been advised not to continue to do so, especially as my employer is not in the same city as me. Actually most days he isn't even the same state (live on the border of two states). I have told them that I don't want to continue to do so because of potential legal concerns, but they obviously want to get reimbursed as do I. Is there validity to this and if so is there any way to get around this issue? Thanks.
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Dansk703 said:
I have been with a new practice for the last 6 months or so and because of lag in credentialing with certain insurances I am being asked to perform injections and seeing patients under my employers EMR log-in (essentially under his name). I had been doing this for a few months to start as I understood there was a grace period of typically up to 90 days as long as there had been a submitted application for approval with the insurance companies. Every time that I would do procedures or see patients under his name, I would always sign my name on the chart. However, as it has been past the 90 days I have been advised not to continue to do so, especially as my employer is not in the same city as me. Actually most days he isn't even the same state (live on the border of two states). I have told them that I don't want to continue to do so because of potential legal concerns, but they obviously want to get reimbursed as do I. Is there validity to this and if so is there any way to get around this issue? Thanks.
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1st of all, you cannot perform a procedure/visit and then bill as another physician. Essentially this is what is occurring and would likely be construed as fraud.

Advise: Get your own log-in and wait until you are officially credentialed on plans.
 
Dansk703 said:
That is exactly what I told them, but they don't seem to want to listen nor think it's a big deal. I have my own log in and have been seeing patients and doing procedures under my own template as I am credentialed with most insurances now, but there are a few I am still pending. I have been just moving the patients/procedures with insurance that I am not yet credentialed on to my template and advising the billing company to hold off on submitting claims until I am credentialed. They seem to think that the practice is "too small" to draw any attention from governing agencies.
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Sounds like you are tying to do the right thing.

Would submit a word of caution, if they subscribe to these practices, what other areas are suspect?
 
I have to say this is maybe the craziest thing I have heard in a while. If I were you I would consult an attorney and figure out your liability and what to do. Your comment above about what you are doing sounds like the right thing. I was in a similar situation once and just didn’t schedule insurances who hadnt credentialed me yet (they eventually did). Watch your own rear as no one else will that’s for sure.
 
What you've been doing so far sounds like fraud, but it sounds like you're aware of this and are taking steps to fix it, so that's good.

If you aren't credentialed with a few insurances, either schedule them with the other docs in the group or see them for continuity and recognize you aren't going to bill those people.
 
This is unfortunately the second job I've taken in about 1.5 years. The first was nightmare filled with legal issues and now it's pretty much the same with this practice. And I thought that I had done a good job of vetting this second job. But I guess not. Unfortunately this might be last the pain job for the foreseeable future as I don't really want to go through the headache of potentially dealing with this again. My non-compete is not great, but there aren't any other jobs available pain in my city anyways. There are no hospital employed pain positions in the city I live. In fact the 2 hospital systems don't have any pain doctors.
 
Dansk703 said:
This is unfortunately the second job I've taken in about 1.5 years. The first was nightmare filled with legal issues and now it's pretty much the same with this practice. And I thought that I had done a good job of vetting this second job. But I guess not. Unfortunately this might be last the pain job for the foreseeable future as I don't really want to go through the headache of potentially dealing with this again. My non-compete is not great, but there aren't any other jobs available pain in my city anyways. There are no hospital employed pain positions in the city I live. In fact the 2 hospital systems don't have any pain doctors.
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Be their guy. Make them compete against each other for you. Practice the way you want ethically and win. BUT you may not be comfortable in this model.

Do you want to be a part of this practice with legal issues long term? Would you really want to become a partner in that?
 
This sounds like some BS. I would refuse.
 
This really sucks for you.. but not as bad as legal problems. Approach the hospitals and offer your wares. You might be surprised. Pain practices are very profitable for hospitals and not that expensive to set up relative to other practices.
 
Laryngospasm said:
This really sucks for you.. but not as bad as legal problems. Approach the hospitals and offer your wares. You might be surprised. Pain practices are very profitable for hospitals and not that expensive to set up relative to other practices.
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I agree that this situation of seeing patient and billing under another doctor must be fraud. We’ve hired 3 doctors in the past few years and having to wait on insurance contracts is just part of the process. No way around it and it sucks for all of us. These guys apparently can’t stand it and want to cut corners.
 
Laryngospasm said:
This really sucks for you.. but not as bad as legal problems. Approach the hospitals and offer your wares. You might be surprised. Pain practices are very profitable for hospitals and not that expensive to set up relative to other practices.
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How much can you make working for a hospital? Seems like you're giving up a lot in terms of the facility fees, and autonomy in the process.
 
6-900k. I make more doing less than I did I private practice. And when I want to take a day or week off I do it. Plenty of autonomy. This may not be true most places. I do lack the ability to order any equipment I want but I also don’t have to pay for it or worry about any day to day operations. Also I don’t have the fear of pissing of the one or two spine surgeons who refer to me because I refuse to take their ****show opioid patients.
 
Laryngospasm said:
6-900k. I make more doing less than I did I private practice. And when I want to take a day or week off I do it. Plenty of autonomy. This may not be true most places. I do lack the ability to order any equipment I want but I also don’t have to pay for it or worry about any day to day operations. Also I don’t have the fear of pissing of the one or two spine surgeons who refer to me because I refuse to take their ****show opioid patients.
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900k and ur hospital based?
 
I haven’t made that yet.. that is on the higher end of what I feel is reasonable, I am on the lower end but am just getting going. I have a PA and another Dr. who doesn’t do many procedures and sends me the ones who need them. Also built in referrals from spine surgeons and ortho. But I do think that is very doable.
 
Laryngospasm said:
6-900k. I make more doing less than I did I private practice. And when I want to take a day or week off I do it. Plenty of autonomy. This may not be true most places. I do lack the ability to order any equipment I want but I also don’t have to pay for it or worry about any day to day operations. Also I don’t have the fear of pissing of the one or two spine surgeons who refer to me because I refuse to take their ****show opioid patients.
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Are you getting any juice from facility fees or that pure RVU/production revenue?
 
Dansk703 said:
I have been with a new practice for the last 6 months or so and because of lag in credentialing with certain insurances I am being asked to perform injections and seeing patients under my employers EMR log-in (essentially under his name). I had been doing this for a few months to start as I understood there was a grace period of typically up to 90 days as long as there had been a submitted application for approval with the insurance companies. Every time that I would do procedures or see patients under his name, I would always sign my name on the chart. However, as it has been past the 90 days I have been advised not to continue to do so, especially as my employer is not in the same city as me. Actually most days he isn't even the same state (live on the border of two states). I have told them that I don't want to continue to do so because of potential legal concerns, but they obviously want to get reimbursed as do I. Is there validity to this and if so is there any way to get around this issue? Thanks.
Click to expand...

that billing practice is only permissible in locums situations (there’s a loophole where locums can bill under alternate provider out of recognition these are short term often emergency arrangements). Payer credentialing does truly take 90 days which is ridiculously inefficient. It could be sped up if you are credentialed under a health system’s group clinically integrated network but that does not sound like it’s the case for you.

also, is the physician you are billing under even licensed in your state? It sounds like yes
 
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