Medicare provider numbers are linked
to street addresses and currently it
is only possible to have one provider
number per doctor and per street
address, and each Medicare provider
number can only be linked to one
electronic-claiming system.
not possible to `share' one provider
number on two different software
systems to lodge claims for services
provided at one street address. It just
can't be done end of story.
provider numbers. I once witnessed
$40,000 of claims for one provider get
`stuck' in the crossfire when the day
after they had been transmitted, but
before they had been paid, the practice
was taken offline due to a careless
administrative error.
hospital provider number to a new
billing system, whereby the public
hospital's revenue stream for his
private patients suddenly dried up
as it was now being diverted to the
provider's own bank account, much to
chagrin of the hospital!
be rectified, but not without
administrative pain and sometimes
significant delays in cash flow. So
it's prudent to always pause before
signing any Medicare form for any
hospital or practice. Ask yourself if
the provider number to which the
form relates is currently in use and
by whom, and is it linked to claiming
software? Sometimes alternative
explaining some of these recurrent
issues faced by providers, I was
advised that it was now possible
to have two provider numbers for
the same doctor linked to the same
address. All I needed to do was prepare
a letter, signed by the provider, setting
out the reasons for requiring the
second provider number at the same
address, and attach it to an application
for an additional provider number.
a client to organise this, by drafting a
carefully worded letter and submitting
it as instructed, I was advised that it
was not possible. Back to square one.
specific, and what exactly does the
legislation say?
clarify a point of terminology that can
sometimes add to the confusion. LSPN
is an acronym for `location specific
practice number', not `provider number'.
imaging services. Any machine used
to provide diagnostic-imaging services
must be registered under an LSPN
to enable the payment of Medicare
benefits at designated rates. LSPNs
exist on a national register, which is
accessible online.
numbers' as such, though it is true
that provider numbers are attached
to locations.
added) is found in Section 19 of the
Act and Regulation 13, the relevant
sections of which are copied below:
SECT 19
Medicare benefit not payable in respect
of certain professional services
(6) A Medicare benefit is not payable in
respect of a professional service unless
the person by or on behalf of whom the
professional service was rendered, or an
employee of that person, has recorded on
the account, or on the receipt, for fees in
respect of the service or, if an assignment
has been made, or an agreement has
been entered into, in accordance with
section 20A, in relation to the Medicare
benefit in respect of the service, on the
form of the assignment or agreement,
as the case may be, such particulars as
are prescribed in relation to professional
services generally or in relation to a class
of professional services in which that
professional service is included.
Regulation 13 as follows:
1975 REG 13
Particulars to be recorded on accounts,
receipts and bulk billing agreement
of the Act, the following particulars are
prescribed in relation to professional
services generally:
the service was given;
(b) the date on which the service
was given;
(c) the amount charged in respect
of the service;
(d) the total amount paid in respect
of the service;