Wiki New pt documentation rules

[Texmexsop1]

I have a surgeon that thinks you can combine the NP doc and physician doc for new patients, and bill for this. I have explained the documentation rules for new pts, but he is adamant. He knows about billing for time (when correctly noted in chart - 50% of ___etc), so that angle is covered. Any suggestions on how to approach this, or how does anyone else do this with NPs and PAs?

 

[RebeccaWoodward*]

I have a surgeon that thinks you can combine the NP doc and physician doc for new patients, and bill for this. I have explained the documentation rules for new pts, but he is adamant. He knows about billing for time (when correctly noted in chart - 50% of ___etc), so that angle is covered. Any suggestions on how to approach this, or how does anyone else do this with NPs and PAs?

"Incident to" does not apply to new patient's in an office setting. The provider and NPP can not combine their notes and bill under the provider's name and NPI. It needs to be one or the other...

SPLIT/SHARED E/M SERVICE

Office/Clinic Setting

In the office/clinic setting when the physician performs the E/M service the service must be reported using the physician's UPIN/PIN. When an E/M service is a shared/split encounter between a physician and a non-physician practitioner (NP, PA, CNS or CNM), the service is considered to have been performed “incident to” if the requirements for “incident to” are met and the patient is an established patient. If “incident to” requirements are not met for the shared/split E/M service, the service must be billed under the NPP's UPIN/PIN, and payment will be made at the appropriate physician fee schedule payment.

http://www.cms.gov/manuals/downloads/clm104c12.pdf

30.6.1 B

 

[LLovett]

Depends on your carrier

For WPS Medicare you can do this, but you have to bill under the NPPs numbers and take the reduction in pay.

For some of my Blues as long as the NPP says the doctor is involved (doesn't even have to see the patient or have any documentation from the doctor, they just need to mention they talked to the doctor) we are supposed to bill under the doctor.

So it can be very different from carrier to carrier. It pays to know the ins and outs of all your local carriers.

Laura, CPC, CPMA, CEMC

 

[Texmexsop1]

Thanks so much for your input. I'll give our major carriers a call !