# Discharge Billing



## Bellaboo (Apr 25, 2008)

Just like to clarify if MD does face to face discharge visit in the hospital but NP does actual dictation for the chart for the MD. The MD can bill for the charge.


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## RebeccaWoodward* (Apr 25, 2008)

The answer is yes...but I would hesitate doing this.

*Can I Use the NPP as a Scribe?*
For some time there has been controversy surrounding the opening question. The dilemma is not “can I use the NPP/PA as a scribe?” but rather “should I use the NPP/PA as a scribe?”
A November 2006 article published by Non-Physician Practitioner News makes valuable and reasonable points. Employing a credentialed billing Nurse Practitioner or Physician Assistant as a human Dictaphone (aka scribe) is unproductive and wasteful. A scribe is defined as someone who writes down (or types) exact dictation. It cannot include any observations by the scribe or any independent thought. Thus, a NP/PA cannot do any more than a recorder or typist function while being a scribe. No H&P, DX, or Plan done using their credentials as a NP/PA medical provider may be employed in a scribed note.
The article states, it is important for physician's to ask themselves “what responsibilities am I willing to share with an NP/PA?” Will they be generating revenue that will compensate for their salary? If I am looking for a scribe would it be in the best interest of the practice to employ a credentialed billing NP/PA for such a position or is there an alternative professional for such a position?
When using anyone as a scribe it is important to follow the guidelines as set for by CMS (Center for Medicare/Medicaid Services). The guidelines state the individual writing the note should note “written by xxxx, acting as scribe for Dr. yyyy.” The scribe is functioning as a expensive, “living recorder,” recording in real time the exact words of the physician as they are dictated to the scribe. Medicare pays for medically necessary and reasonable services and expects the person receiving payment to be the one delivering the services.


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