Risky Games With Provider Identification Numbers

Only the provider who examines and treats the patient can bill under his/her provider identification number. Billing for services under one physician’s name and identification number when another doctor actually rendered the services, whether inadvertent or intentional, is called “Provider Misidentification” and is inappropriate.

In the Compliance Program Guidance for Physician Practices, the OIG describes coding as one of the four major risk areas affecting physician practices which includes “knowing misuse of provider identification numbers that results in improper billing.”  Also, in a footnote in this guidance the OIG describes the kind of practice that compliance programs should prevent:  “The practice bills for a service performed by Dr. B, who has not yet been issued a Medicare provider number, using Dr. A’s Medicare provider number.  Physician practices need to bill using the correct Medicare provider number, even if that means delaying billing until the physician receives his/her provider number.”

We must all work together to correctly identify the provider who rendered the service and to refund any mistakenly obtained reimbursement.  Please contact us if you have any questions.

Nicole Almiro