Wiki documentation of visit by Dr or NP

[JTE79]

Question is this: Nurse Practitioners (NP) sees and exams patient for follow up visit (FUV) and the doctor also sees and examines the patient and but does not document correctly per guidelines that he saw and examined the patient during the FUV the billing must then go under the NP. Is this a compliance issue that the doctor did see and examine and did not document so? Or per the doctors standpoint simply a billing issue that is not worth his time and effort to state in the note that he saw and examined the patient thus getting credit.
Please see the sample doctor response to request to document attestation.

What financial difference does it make? From what I understand, the NP can bill 85% of my bill. That might correspond to about $3 total difference (total guess on my part). This is what we were trying to say in the billing meeting where NP assistance came up. The small increment in pay may not be worth the additional effort in documentation.

 

[pamsbill]

Well, unless he is getting $20 for a visit, it will be more than $3.00. However, your question is really more complicated than it would seem. In order to bill it under the physician, there are several qualifications which need to be met.

If you are going to bill it under the physician as "incident to," the patient must be an established patient, must have no new problems or issues, the physician must be on site at the time of the visit and the NP must be following an established plan of care. Some auditors will say this happens in less than 10% of the cases because most all patients have some additional "thing" they want to address. If all the criteria are met, you can bill the visit as "incident to" and bill it under the physician. Otherwise, you have to bill it under the NP.

There is such a thing as a "shared visit" which is the NP doing part of the visit and the physician doing part of the visit. In these cases, the physician must document a portion of the exam, history or medical decision making. Simply signing off or adding a statement such as "I agree with the plan of care" is not sufficient. My guess is Medicare assumed you billed it as a shared visit but the doctor did not document any of the 3 areas necessary.

Honestly, we bill mostly everything under the mid-levels when they do the service. This is primarily because it becomes difficult for the mid-levels to distinguish whether it fits the "incident to" guidelines and it becomes a compliance issue. I'm sure there are practices that have it mastered, but most do not. If I were you I'd be glad he just wants it billed under the NP. At least that is one area for which you will not have to worry about a Medicare audit.