Q&A: Billing for services from doctors who haven't been credentialed

January 9, 2009

A provider must render the service in order to bill for it; simply signing the chart is not providing the service.

Q: We have several new physicians in our practice. It is very frustrating to have delays in the credentialing process caused because insurance companies "lost" the information sent to them; at the same time, they have eliminated our ability to retroactively bill for our physicians' services. I have heard that if one of the credentialed doctors in the group signed the chart, the services of the new doctor could be billed using the credentialed doctor's provider number. Has something changed to allow us to do that?

A: It depends. For Medicare and most major insurers, providers cannot bill for their services until they are credentialed (Medicare still allows a 30-day grace period). Some local HMOs will allow billing of a new provider's services if the group is already credentialed. The requirements to do so vary, so you need to check with each insurer to find out their requirements. With regard to another doctor signing charts: The provider must render the service in order to bill for it (or oversee the provision of the service as in "Incident To" services). Signing the chart is not providing the service. That process could be interpreted as fraudulent billing