# Nurse Practitioner Billing for hospital consults



## ragivens (Jan 16, 2013)

The nephrologist office I work for has recently hired a nurse practitioner.  She will be responsible for dialysis rounds as well as hospital consults/follow ups.  
The billing manager is stating we can bill under the physician's NPI even if the physician does not see the patient. He is stating all the physician will need to do is sign off on the NP's H&P.  I am finding conflicting information on this and am unsure how to bill. The Medicare guidelines I read seem to indicate we can bill under the physician NPI as long as the NP is employed by the physician. 

Are we required to bill under the nurse pracitioners NPI or can we bill under the physician's only?  Any help on this would be greatly appreciated! I'm new to NP billing.


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## kagal0816@verizon.net (Jan 16, 2013)

*NP Billing*

Hi, Nephrology is not my specialty, but here is a great article on PA billing.  My understanding is that the physician must be physically present when the services are rendered to qualify for Incident-To billing.  Who would be the supervising physician and would that physician be available?  Co-signing records when the MD was not in the location, does not sound right to me.  

I would be very careful until you are able to confirm the information from the billing manager, this does not seem quite right.  

Good Luck, Karen Gallagher, CPC


http://www.physicianspractice.com/blog/understanding-physician-assistant-reimbursement


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## AprilSueMadison (Jan 16, 2013)

The supervising physician does have to be on premises as the previous poster indicated.  

http://physicianlaw.foxrothschild.c.../be-mindful-of-the-medicare-incidentto-rules/

The above is a pretty simple to understand outline of the incident to rules


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## ragivens (Jan 16, 2013)

Thank you, both these articles where very helpful.  Should I be billling under the NP's NPI instead of the physician's?


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## ragivens (Jan 16, 2013)

Thank you, both these articles where very helpful.  Do you know if I should be billling under the NP's NPI instead of the physician's?


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## cheermom68 (Jan 16, 2013)

"incident to" does not apply to the hospital setting.  In order to bill a NP visit under the MD's number in the hospital setting, what is called "split/shared" must happen.  This means that both the NP and doctor must see the patient on the same day(doesn't have to be at the same time) and document what they did.  There must be some type of proof that there was a face to face with the MD. Search "split shared" on the CMS website or your individual carrier.


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