full image - Repost: Umbrella NPI's and referrals question (from Reddit.com, Umbrella NPI's and referrals question)
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Rookie here.My friend, Dr. A, thought she was billing legally for years through the guidance of an “experienced” (scam artist)Director of Operations - Scam Artist D.O. was finally caught and fired 2 months ago (August 2024), and I am swooping in to help clean up the mess she left behind.The issues I'm finding that were missed or blatantly ignored are…appalling.My experience with medical billing is minimal, but my understanding of it has grown through managing another providers practice and hiring an external biller through our EHR. Dr. A used to be a sole specialist provider, but as her popularity and practice grew, she hired on NP's and PA's and other providers of the same specialty to see patients. To simplify things, everyone was to be billed under her NPI and Tax ID, tied to Address1. So if you are in network with Dr. A, you are also fine to see the PA, NP, and Dr's B, C & D at that same location.I know this is perfectly normal in medical coding, and perfectly legal in the US.however.One of the things Scam Artist was responsible for was making sure Dr. A was properly credentialed. Dr. A had hired Company X to handle all her credentialing, and all Scammer had to do was keep up with their Company X account and pay dues on time.Scammer neglected to do this starting in June 2024(probably extends further back than that), that was when Company X supposedly fedexed a document to our office that if we don't pay them by a certain date, they will terminate our contract. We never received this.So we get de-credentialed with 3 major insurances. UHC, BCBS and Cigna. But only under Dr. A’s NPI. Bad part is that we bill ALL our appointments and testing under her. We found this out in the beginning of September and are trying to rectify it. However, we have been seeing patients this entire time, not knowing that we were de-credentialled, so we haven't been paid for anything.Luckily, there are a lot of appointments that were done by other providers and we can re-bill under their individual NPI’s.But now I'm coming across a referrals issue–if a patient needs a referral with that specific doctor's NPI, but that doctor isn't credentialed specifically under our address, would that patient be able to get coverage?We’ve been getting paid for resubmitted claims under individual provider NPI's for regular visits, but I know that referrals can get weird when it comes to network status.Can anyone advise?
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