Practice Management Alert

A visit may lose its incident-to status if the PA or NP discovers a new problem If you have a physician assistant (PA) or nurse practitioner (NP) working alongside the physicians in your practice, you need to be sure you're always billing under the correct provider identification (ID) number. Not only that, but some third-party payers do not recognize PA or NPID numbers, and require you to bill your nonphysician services another way, says Patricia Trites, MPA, CHBC, CPC, CHCC, CHCO, CEO of Healthcare Compliance Resources in Augusta, Mich. You need to be aware of your different payer requirements, as well as the "incident-to" billing rules, she advises. Follow these expert tips for flawless billing of your PA's and NP's services: Physician's ID Number -- Bill under the physician's ID number if the visit meets all the incident-to rules: if the physician is on-site and available and if the PA or NP sees a patient who is already established under the physician's plan of care -- Use the ID number of the supervising physician who is on-site and available on the date of service. This doesn't necessarily have to be the same physician who started the patient's care, Trites explains. Using the ID of the on-duty supervising physician makes more sense in terms of billing compliance. If a carrier reviews your scheduling records and sees that you billed services under a physician who was on vacation or out of the office, that could spark an audit, she says. Remember: The supervising physician is the physician on-site and available on the date of service, not the physician who previously supervised the patient's care plan. "If there are multiple physicians on-site and available," you should use the ID number of the physician who initiated the patient's care, if he is present, Trites says. PA's or NP's ID Number -- Bill under the PA's or NP's ID number if the visit doesn't meet all the incident-to rules: if there is no supervising physician on-site or if a new patient presents who is not already under the physician's plan of care. See "Incident-to" Billing Review at right. -- Report treatment for a new problem under the PA's or NP's ID number. If the physician establishes a patient's plan of care but the patient presents with a new problem and only the PA or NP renders treatment, this visit does not meet incident-to billing requirements, Trites says. -- Beware a split-billing problem when the PA or NP treats an established problem under incident-to rules but a new problem arises during the course of the visit. Once the PA or NP begins treating the new problem that has no previously established care plan, the visit loses its incident-to status, Trites says. [...]