Wiki AWV's Billed Under Supervising Physician

[dmack]

Can an AWV that is performed by a Nurse Practitioner with their own NPI, be billed under the supervising physician? Incident To does not apply to AWVs as they have their own benefit category, however, when an AWV is performed by a "team of professionals working under the supervision of a physician" - it is the supervising physician who will bill Medicare Part B for the visit. Does the NP qualify as part of the team of professionals or does that need to be auxiliary staff who do not have their own NPI?

 

[Pam Warren]

The 'team of professionals' typically means nurses or other clinical staff who can perform the AWV (as long as it's in the scope of practice), and be billed by the supervising MD. The APRN could either bill under their own NPI or under the MD's supervision. Although incident-to guidelines don't apply, the supervision rules do....provider must be onsite.

 

[dmack]

The 'team of professionals' typically means nurses or other clinical staff who can perform the AWV (as long as it's in the scope of practice), and be billed by the supervising MD. The APRN could either bill under their own NPI or under the MD's supervision. Although incident-to guidelines don't apply, the supervision rules do....provider must be onsite.

Thanks, Pam. So........just to be clear - the APRN who is performing & documenting the entire AWV, can bill under their supervising physician & receive 100% of the fee schedule rather than 85%? They get to choose since only supervision rules apply? Are the supervision rules still waived for the duration of the pandemic?

 

[Pam Warren]

The supervision rules apply regardless of the pandemic. And yes, you can bill under the MD but retain 100% of the fee schedule. But the provider has to be in the suite....can't be off on vacation or over at the hospital. That's why sometimes it's better to have your midlevels bill under their own NPI.

 

[thranowski]

The supervision rules apply regardless of the pandemic. And yes, you can bill under the MD but retain 100% of the fee schedule. But the provider has to be in the suite....can't be off on vacation or over at the hospital. That's why sometimes it's better to have your midlevels bill under their own NPI.

In our state statutes, it says that supervision includes access via telecommunication, they don't have to be physically present. That is not the case everywhere, I assume?