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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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