In group practices, understanding reimbursement workflows is critical for practice managers, healthcare providers, and owners. Here’s how it works:
Rendering Provider Role:
Each provider delivers patient care individually, acting as the rendering provider for their services.
Group’s Role as Billing Provider:
The group serves as the billing entity. Reimbursements from payers are directed to the group, not individual providers, regardless of who rendered the service.
Handling Provider Transitions:
When a provider leaves, the group can still bill and receive payments for services performed during their tenure. Ensure the provider’s NPI is linked to the group’s Tax ID, and claims are submitted under the group’s billing details.
Documentation & Compliance:
Accurate records of services rendered by the provider while in the group are essential. This ensures timely claim processing and avoids payment delays.
In summary, as the billing entity, the group retains reimbursements for services rendered by any provider, even after they leave, provided claims are submitted correctly and on time.