Wiki NPP (APN) billing question

[AmandaW]

Wanted some clarification to what I've read about NPPs (APN) billing initial visits in the hospital in Arkansas. Jurisdiction JH on Novitas.
I see where IF the Dr doesn't see the patient and perform his element of the note then it CAN'T be billed under the Dr but can be billed under the NPP's NPI. Is that true for initial visits? Can the APN bill that first initial consult/inpatient or Outpatient (like in Observation) or does the Dr have to first see the patient and establish a 'plan of care'? I'm seeing conflicting information. Also, could you please provide a link to this information?

 

[thomas7331]

NPPs can bill (under their own ID) for the initial hospital visit if they perform them, assuming it is within the scope of their license in the state in which they practice.

The rule that a physician must see the patient and establish a plan of care pertains to 'incident to' billing where services performed by the NPP are billed under the physician NPI. But 'incident to' billing only applies to the office setting - in the hospital, services must always be billed by the provider who performed them. The exception is for a split/shared visit, if both providers see the patient and each performs part of the E/M service, which Novitas describes here:

https://www.novitas-solutions.com/w...ntentId=00004983&_adf.ctrl-state=okzrsh6ng_55

You can also find additional information about 'incident to' and shared visits here, see section 30.6.1:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c12.pdf