Wiki Incident to and np clarification

[DHARRIS0286]

I'm checking to see if I have this correct...
If I'm billing for our Nurse paractitioner incident to for Medicare...I bill it using the supervising MD's npi number and name as if he has done it himself. No modifier needed and the NP's name is no where on the claim right?

Then for other payers they may or may not accept this. In which case I would have to change it to bill for the NP directly correct?

Here I have a question. If I have to bill for the NP directly does her name go on the claim and if so where? And do we still put the MD's name and NPI down on the claim with the modifier SA showing that the NP saw this patient?

This is very confusing and I want to bill this out correctly since we just hired a NP to shadow our MD at home visits and assisted living facilities.

 

[Donna T]

If an NP and a physician work together to provide physician services, the services can be billed under the physician's provider number, to get the full physician fee, under the Medicare provision for "incident-to billing." If the NP sees the patient and it doesn't meet incident to guidelines (for example, the NP works in a satellite office with no physician in attendance) then you'd bill under the NP's name and NPI # and the NP would be reimbursed by Medicare at 85% of the physician rate. We do not use an SA modifier.

 

[DHARRIS0286]

NP Billing

Thank you!! I read all these things about some plans taking the SA modifier and obvisouly Medicare doesn't but it's so confusing when you get different answers all over the place. I work for Hospitalists and Nursing Home Doctors and bill for the providers not the facilities. We even do Home visits so it is very difficult to figure everything out.

 

[npricercm]

incident to and np clarification

I'm checking to see if I have this correct...
If I'm billing for our Nurse paractitioner incident to for Medicare...I bill it using the supervising MD's npi number and name as if he has done it himself. No modifier needed and the NP's name is no where on the claim right?

Then for other payers they may or may not accept this. In which case I would have to change it to bill for the NP directly correct?

Here I have a question. If I have to bill for the NP directly does her name go on the claim and if so where? And do we still put the MD's name and NPI down on the claim with the modifier SA showing that the NP saw this patient?

This is very confusing and I want to bill this out correctly since we just hired a NP to shadow our MD at home visits and assisted living facilities.

--

I was once told that you could only bill incident to in an office setting.

Incident to" services are defined as services commonly furnished in a physician's office which are "incident to" the professional services of a physician (MD or DO) and are limited to situations in which there is direct physician personal supervision.[/I]

I would verify with medicare before billing home or assisted living facility as incident to.

 

[Donna T]

You are correct - incident to billing is not permitted in hospitals, skilled nursing facilities or in the home. However, an NP or PA can see a patient in the home setting but they would have to bill under their own NPI # and get reimbursed at 85% of the medicare fee schedule.

 

[npricercm]

incident to and np clarification

i agree Donna, the NP or PA should get their own provider number so they can bill independently at a reduced rate. You must also be aware of the contractural relationship between the physician and the non-physician providers (NP/PA).