Date: 01/05/2000
Q:
Our four-person internal medicine practice
is planning to add a fifth physician within the next six months. We are
currently in negotiations with a candidate and hope to reach agreement
in the very near future. We participate in many managed care plans and
are concerned that the new physician won’t be credentialed on all of the
plans before she begins employment. Our office manager suggested we bill
for the new physician’s services under one of the other physician’s provider
numbers until the new physician’s credentialing is complete. Is this a
good approach?
A:
We wouldn’t recommend it. This would almost
certainly violate your agreements with the managed care plans and most
likely constitutes insurance fraud. A better approach would be to immediately
schedule the new physician for an intensive “application session” with
your credentialing coordinator as soon as the employment agreement is executed,
even if this means a separate trip to your practice. During this visit,
try to have all of the managed care applications available (as well as
those for hospital privileges) and have all of the applications completed
as soon as possible. In addition, the employment agreement should specify
that the associate must have applied to all of the managed care plans with
which the practice participates at least 120 days before commencement of
employment. If not, the employment agreement should further specify that
the commencement of employment could be delayed if this important stipulation
is not met.
Russell B. Still(bio...)
Vice President
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