[J_is_my_initial]

I work in a call center that takes calls for the er dr bills. It sounds like the hosp outsources thier er services. The company I work for supplies drs to ers across the country. When a non par dr treats someone at a participating hosp we adv to call the ins and appeal it. Tell them you had no choice of what drs to see and that the hosp is participating. Many times they will go back and pay the participating rate. Most times the dr themselves do not know whether or not they are par as they do not do their own billing. Our company takes care of all of that. It is not a matter of coding. We list the dr that signs the records. This may or may not be the person you actually saw. It would be the dr in charge while you were there. For some reason that med grp decided not to be par with medicare, it could be they could not come to an agreement with them over the contract. I deal with this every day just on the physcian's (medical) side.