Who is a requesting provider

In the case where a substitute provider locum tenens was used, that individual is considered the Rendering Provider. The Rendering Provider does not include individuals performing services in support roles, such as lab technicians or radiology technicians.

Supervising Provider The Supervising Provider is the individual who provided oversight of the Rendering Provider and the care being reported. Purchased Service Provider A Purchased Service Provider is an individual or entity that performs a service on a contractual or reassignment basis for a separate provider who is billing for the service.

In the case where a substitute provider a locum tenens physician is used, that individual is not considered a Purchased Service Provider. The more you know about the range of providers involved in medical care, the better prepared you can be, at least in non-emergency situations.

A growing number of states have passed laws to limit patients' exposure to balance billing in situations where some providers at a given facility aren't part of the insurance networks with which the facility contracts. And federal rules take effect in that eliminate surprise balance billing in emergency situations and in situations where an out-of-network provider performs services at an in-network facility. Ground ambulance changes won't be affected by this new rule and they account for a significant number of surprise balance bills each year , but the new rule otherwise provides solid consumer protection.

Federal regulations also took effect in , applicable to health plans purchased in the health insurance exchanges , that provide a modicum of protection when patients are subject to surprise balance billing. Exchange plans are required to apply the out-of-network charges from ancillary providers i.

But the patient is still responsible for paying the out-of-network charges, and the regulations don't require any sort of cap on those charges. Fortunately, the new rules that take effect in are much more robust in terms of protecting consumers from surprise balance billing.

Some states had already tackled the problem on their own, but in many states, surprise balance bills are still common. And self-insured group plans are regulated under federal rules rather than state rules. The majority of people with employer-sponsored coverage are enrolled in self-insured plans, and state regulations don't apply to these plans.

This is why federal action was needed, and why the regulations that take effect in will provide much more significant protection than anything states had done on their own.

But regardless of the rules that are in place, the more questions you ask ahead of time, the better off you'll be. Inquire about the insurance network participation of any providers who might treat you—directly, or indirectly, as would be the case with durable medical equipment supplies, radiologists, and labs. Ask the hospital or clinic if there's an in-network provider option in each case, and state your desire to utilize in-network providers—keeping in mind that "provider" goes well beyond the healthcare provider overseeing your care.

Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Cornell Legal Information Institute. Kona M. State balance billing protections. The Commonwealth Fund. April 22, Federal Register. Department of Health and Human Services. Kaiser Family Foundation. October 8, But that's how they do it. A lot of times it is a resident dictating a consult, and so they'll--for instance if it's an otolaryngology resident--say, "Referring physician," and give the otolaryngology attending's name and then say, "Requesting physician," and give, for example, the ER doc's name who referred the patient to Otolaryngology in the first place.

So I know in the header info where the dictating resident's name populated into all fields, the one field that's labeled for the attending, I change that one to the doc he is calling the "Referring physician," even though to me "referring" and "requesting" mean the same thing--the attending of that service being referred to is NOT in my opinion the "referring" physician, the ER doc would be, but that's what they mean anyway.

Hope that helps. ER doctor refers patient to someone who can admit the patient to the hospital. Managing doctor can refer patient to another doctor same or different specialty for second opinion or consult. In the example already given to you, the otolaryngologist resident has a supervising physician, not a requesting physician.

The words are commonly used interchangeably. In coding, the managing physician has a separate set of evaluation and management codes than a consulting physician. Oct 17, Is a requesting doctor the same thing as a referring doctor? Physician Look-ups Nov 23, Does anyone have any good websites for looking up physician names? Started a new job and I am all over the country on some of these physicians. Sometimes i have a full name, other times just a last name and no clue as to what the speciality is.

Thanks in advance for your help. Physician Thank You Dec 08, So, I'm editing this report and it comes to the end and the physician states, "Transcriptionist, thank you so very, very much.

I appreciate you and your work. Since this physican doesn't know it was me doing the report, I wanted to pass it on so hopefully it'll make someone else's day too.

Please no negative comments. I have enough negative as we all do. Let me just enjoy the thank-you, and even more the appreciatio Resident Physician Nov 26, I have alway been told when in doubt, leave a blank. Resident did not give attending physician's name. There was a doctor's name in the hearder as attending, but I was not sure so I left the attending line blank at the bottom of the report.

My boss calls me and tell s me to go on a limb and guess in the future. I do not like those ethics because it leaves me up for problems in the future. Comments welcomed. Physician's Addresses Sep 01, What's a good website to use to get current addresses of physicians?

One Physician Transcription Oct 06, I have been approached by a physician to do his transcription. This is to be done at home. What equipment will I need for transcribing also, what equipment will the physician need for dictating? I appreciate all your suggestions. I have done transcription for this doc at a hospital. He wants me to do the transcription for surgeries he does in a different location other than Associated Or Associative Physician Sep 14, The doctor I transcribe for sometimes says "Associated Physician" and sometimes says "Associative Physician" and then lists the doctor's name.