Wiki Incidnet to billing

[aaronyoutt]

One of the physicians I work for just got back from a conference where she learned that if a midlevel provider does a new patient visit we can never bill incident to for that patient. Regardless if a MD does an office visit in the future, and make their own diagnosis and treatment plan.

I have checked the Medicare website and everything I have read only states that the treatment plan has to be made by the Physician and the PA must follow it.

Does anyone have any insights into this?

Thank You!
Aaron

 

[mitchellde]

One of the physicians I work for just got back from a conference where she learned that if a midlevel provider does a new patient visit we can never bill incident to for that patient. Regardless if a MD does an office visit in the future, and make their own diagnosis and treatment plan.

I have checked the Medicare website and everything I have read only states that the treatment plan has to be made by the Physician and the PA must follow it.

Does anyone have any insights into this?

Thank You!
Aaron

If you go to the Medicare Internet Only Manual (IOM) and sea ch for incident - to you will see where it states this cannot be a new patient. Incident-to means this visit is incident -to the provider having already examined the patient for the same diagnosis. If the provider sees the patient and writes a plan of care then if the NPP is following up on that plan of care it can be billed incident-to as long as the provider is in the office suite at the time of the encounter yet. If the established patient presents with a new problem, it cannot be billed as incident-to.

 

[CodingKing]

I have checked the Medicare website and everything I have read only states that the treatment plan has to be made by the Physician and the PA must follow it.

Correct. Treatment plan would not exist if its a new patient. It can't be another practices plan of care. it's the supervising physicians (the one listed as rendering) plan of care.

 

[cwells]

Unless the mid-level is credentialed and has her own NPI #. In that case he/she can bill for Mcr new patient as long as they are billing the claim out under their own NPI#.

the MD receives 100% of the allowed fee schedule and the mid level if billed under her own number will receive 85% of the allowed.

That means she would file the claim with her name on it and not the docs.

 

[shanakalista]

Clarification

If you go to the Medicare Internet Only Manual (IOM) and sea ch for incident - to you will see where it states this cannot be a new patient. Incident-to means this visit is incident -to the provider having already examined the patient for the same diagnosis. If the provider sees the patient and writes a plan of care then if the NPP is following up on that plan of care it can be billed incident-to as long as the provider is in the office suite at the time of the encounter yet. If the established patient presents with a new problem, it cannot be billed as incident-to.

I think what he is trying to say, is that if the mid-level sees the patient 1st (New patient visit) that even if they follow up with an MD, a new treatment plan was made, then goes back to the mid-level to follow the MD's treatment plan, you cannot bill incident to because the patient established care with the mid-level.